NR 507/NR507 Final Exam (Latest 2024/2025) Chamberlain College

NR 507 Final Exam Which of the following is true regarding a complicated urinary tract infection? - ✅Can be caused by a structural urinary tract disorder Which of the following is a risk factor for the development of a urinary tract infection (UTI)? - ✅pregnancy A symptom of a lower urinary tract infection includes: - ✅urgency Women are at a higher risk for the development of a UTI because of having a shorter urethra. - ✅true Which of the following can help to prevent a UTI? - ✅increase water consumption Risk factors for a UTI - ✅pregnancy sexually active post-menopause estrogen-deficiency women (shorter urethra) catheterization An upper UTI is less common in men due to the longer urethra and ureter structures that make it more difficult for bacteria to reach the kidney. - ✅true complicated UTI - ✅-A UTI that extends beyond the bladder -Caused by structural or functional urinary tract abnormalities or untreated UTI -Infants and older adults affected -Associated with:indwelling cathetersrenal calculiDiabetesPregnancy uncomplicated UTI - ✅-Occurs in the normal urinary tract -Responds well to a short course of antibiotic therapy -Simple cystitis in non-pregnant women without any urologic abnormalities Most common cause of UTI bacteria - ✅E coli Uncomplicated UTI - ✅Protein +/_ Leukocyte Esterase + Nitrites +/_ RBCs +/_ WBCs +/> 5000/hpf Casts - None

Complicated UTI - ✅Protein +/_ Leukocyte Esterase + Nitrites +/_ RBCs + WBCs +/> 100,000/hpf Casts + NP education - ✅-Drink more water.

-Although there are differences of opinions, cranberry juice and vitamin C can help to acidify the urine.

-Urinate before and after sexual intercourse to remove bacteria from the urethral area.Encourage the female to avoid holding urine for extended periods of time -Avoid the use of hygiene sprays and spermicides because they alter the normal microbial flora to enhance the risk for infection.

-Encourage the female to wipe from the front to the back after a bowel movement to avoid spreading bacteria to the urethra -Encourages showers rather than bathing to avoid the spread of bacteria.

A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner.

The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with: - ✅cystitis J.S. is an 80 -year-old patient who resides in a local nursing home. He recently became confused and then fell while ambulating to the bathroom three days ago. Because of his confusion and fall, he was transferred to the acute care facility for evaluation and treatment. Lab work revealed that the patient was very dehydrated with hypernatremia identified and appropriate intravenous fluids started. Cystitis was also identified from the urinalysis. He was also noted to have red and excoriated skin between the buttocks and inner thighs due to urinary frequency and dribbling. To help with skin healing and to prevent further urine leakage, an indwelling catheter was inserted. Two days after the catheter was placed, the patient spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense, foul odor was noted in the urine. On examination of the flank area, the patient yelled out when touched. A urine culture was obtained and came back positive for nitrites and RBCs. Urine microscopy revealed >100,000 WBC/hpf and casts.

Based on the information provided in the case, the patient can most likely be diagnosed with: - ✅pyelonephritis Identify the major risk factor J.S. has that is associated with pyelonephritis: ✅indwelling foley catheter The urinalysis of a patient with a complicated UTI will show WBCs and casts - ✅true

Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are gram negative because of the presence of: - ✅nitrites A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit. - ✅true - NP will want to rule out STD The NP would know that the patient most likely has an uncomplicated UTI because: ✅The UTI responds well to a short course of antibiotics A common organism that causes a urinary tract infection include: - ✅Staphylococcus saprophyticus.

The purpose of straining in BPH is to overcome the obstruction encountered during urination. - ✅true The peripheral zone of the prostate is the largest zone. - ✅true On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings? - ✅a hard nodule There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer. - ✅false - BPH does not lead to prostate cancer The patient most often develops symptoms of BPH when: - ✅The prostatic urethra becomes obstructed.

A 72- year-old male presents to the primary care office with complaints of lower urinary frequency and urgency that have become progressively worse over the last 6 months.

He also reports having to get up more than 5 times/night to urinate where he feels like his bladder is never emptied. He is especially embarrassed because of "leaking" after urination. He denies any fever, weight loss or bone pain. His only medical history is hypertension where he takes atenolol 50 mg po daily and Aspirin 81 mg daily. His family history is negative for malignancy. A urinalysis was performed with negative results, ruling out UTI. The NP performs a focused urological exam and notes the following: Digital rectal exam (DRE): a profusely enlarged prostate with normal shape and symmetry. No nodularity or tenderness is noted.

Palpation of the suprapubic area reveals some bladder distention and discomfort.

Currently, the NP opts to prescribe a 5-alpha reductase inhibitor to shrink the prostate gland and an alpha-1 antagonist to relax the smooth muscle of the bladder next to increase urinary flow.

In terms of the cause of his symptoms, he is most likely experiencing age-related symptoms that are both irritative and obstructive in nature. Match each symptom below as either irritative or obstructive. - ✅Irritative: - Urinary frequency, nocturia, urgency that results from bladder hypertrophy and dysfunction Obstructive: -Incomplete emptying, postvoid dribbling The action of a 5-Alpha-reductase inhibitor causes: - ✅Shrinkage of the prostate gland Men who have BPH are prone to developing a UTI because: - ✅Stagnated urine in the bladder promotes bacterial growth.

The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. - ✅true The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. - ✅true The location of the characteristic hyperplastic nodules of BPH is: - ✅In the periurethral zone.

The type of stone that forms due to a urinary tract infection is: - ✅Struvite stone Renal stones are formed when calcium and oxalate in the urine combine. - ✅true Renal calculi are typically confined to the bladder. - ✅false The most common type of stone is: - ✅calcium stone The gold standard for diagnosing a renal stone is a urinalysis. - ✅false (CT scan) A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high-power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone. Upon follow-up in the office a week later, the patient reported that he was diagnosed with a kidney stone, but he was not aware of the type of stone or the cause for it. He was very concerned about why he had the associated severe flank pain and asked the NP why the pain was so severe and how could he avoid another stone in the future.

Since this is the patient's first episode of having a kidney stone, it is most likely a calcium stone. It is the most common stone with the cause unknown. If there was an opportunity for the patient to pass the stone, it could be analyzed to determine the type.

The NP discusses the cause of the pain and tells the patient that stones travel down the ureter to produce renal colic. The pain intensifies if the stone lodges in the ureter that creates almost unbearable pain. The NP also addresses prevention measures with the patient. Identify below which measures the NP should recommend. - ✅A balanced diet Adequate hydration Lithotripsy is an invasive procedure used to break up the stone - ✅false The most common stone found in the patient with gout is: - ✅uric acid stone Hematuria can be seen with kidney stones because: - ✅The stone injures the urinary structures as it passes through them.

Renal colic is caused by the passing of the stone through the ureter. - ✅true At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone. - ✅ Which of the following actions will relax the detrusor muscle of the bladder? ✅Activation of Beta-2 receptors by the sympathetic nervous system.

The relay station in the brain that plays a major role in regulating micturition is: ✅Pontine micturition center The location of the internal sphincter is under the urogenital diaphragm. - ✅false When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict. - ✅true The levator ani muscle plays a major role in constriction of the external sphincter. ✅true stress incontinence - ✅Leakage of urine with activity Increased intraabdominal pressure causes leaking because there is no resistance to counteract the intraabdominal pressure urge incontinence - ✅Leakage of urine with sensation of need to urinate Detrusor muscle hyperactivity leads to urine leakage neurogenic incontinence - ✅Unimpeded urine leakage Neurological lesions alter nervous system impulses that innervate the detrusor muscle.

The result is decreased bladder compliance and decreased sphincter tone overflow incontinence - ✅Leakage of urine is associated with urgency, frequency, dribbling and hesitancy Leakage is due to retained urine in the bladder that leads to overdistention A 54-year-old female reports to the primary care office with complaints of frequent urination. She reports that she is "leaking" urine several times a day, especially when she coughs, sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or any urgency. The NP looked at the patient's previous urine culture obtained approximately 1 month ago and determined that it was negative. Other than her urinary complaints, she is in otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The NP performs a physical exam and all findings are normal. The urinalysis obtained was negative as well.

Based on patient's symptoms and negative physical exam, she has a typical BLANK. The leaking occurs when the abdominal pressure increases during coughing, sneezing, and lifting. We can rule out urge incontinence because the denied urgency with her urination. We could not diagnose an overflow incontinence because there is nothing in her history that points toward any condition that would cause an overextended bladder such as diabetes or a neuropathic issue. The NP can consider her age as a factor in the development of BLANK due to estrogen-deficiency post-menopause. Lack of estrogen results in vaginal atrophy that results in a relaxed external sphincter. Initially, the NP can suggest pelvic strengthening exercises (Kegel exercises). If these are unsuccessful, pessaries that provide pelvic support and surgery may be indicated. - ✅1. stress incontinence 2. stress incontinence A sphincter malfunction that prevents urine from flowing out of the bladder would most likely result in: - ✅overflow incontinence The major cause of stress incontinence in women is hypermobility of the external sphincter. - ✅true The pathophysiology of neurogenic bladder is: - ✅Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone.

Involuntary loss of urine caused by dementia or immobility is known as: - ✅functional incontinence Which of the following is considered be a transient cause of urinary incontinence? ✅UTI A pre-renal cause of acute renal failure is: - ✅hypotension (reduces blood flow to kidneys)

One of the first pathophysiological responses to the decreased GFR in acute renal failure is: - ✅Activation of the renin-angiotensin-aldosterone system.

One of the major markers for glomerular filtration rate is creatinine. - ✅true Pre-renal is the most common cause of acute renal failure. - ✅true The most common cause of acute renal failure is due to a pre-renal failure. - ✅true Acute-renal failure - ✅Oliguria (< 30ml/hr).

Increased blood urea nitrogen (BUN) and creatinine.

Fluid and electrolyte abnormalities. pre-renal - ✅sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness Intra-renal - ✅direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply post-renal - ✅sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury In post-renal failure, the damage occurs in the collecting duct. - ✅true In intrinsic renal failure, sodium and water excretion is increased which leads to a dilute urine. - ✅true Which of the following is the best indicator of a good prognosis for recovery from acute renal failure? - ✅The kidney responds to furosemide Which of the following is true regarding creatinine? - ✅Creatinine gets freely filtered from the glomerulus One of the issues that requires management of a patient with acute renal failure is hypokalemia - ✅false The result of vitamin D deficiency results in: - ✅hypocalcemia The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined. - ✅true Stage III kidney disease is signified when the GFR drops below 60. - ✅true

Which of the following is a complication of decreased GFR? - ✅anemia The anemia seen in renal failure is due to the lack or iron. - ✅false symptoms of CKD - ✅hypocalcemia and hyperphosphatemia anemia electrolyte abnormalities uremia fluid overload Long term management of CKD - ✅Dietary management: patients will be on a low potassium, low sodium, and low phosphate diet.

Fluid restriction: patients will restrict fluids to 500 mL to 1L/day or an amount that does not cause volume overload.

ACE Inhibitor therapy: Lisinopril, enalapril, captopril will be prescribed to provide renal protection for patients in Stage I-III. Medication avoidance: patients will avoid nephrotoxic drugs such as non-steroidal antiinflammatory drugs (NSAIDS) and aminoglycosides.

The decision to begin dialysis is guided by the patient's symptoms rather than GFR. ✅true End-stage renal disease is signified by a GFR of: - ✅less than 15 Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function. ✅false The major acid/base disturbance in renal failure is: - ✅metabolic acidosis Dietary management of a patient with CKD includes: - ✅Low potassium, low sodium, and low phosphate diet.