NURS 660 CORE EXAM TEST UPDATED QUESTIONS AND
SOLUTIONS RATED A+
✔✔UTI Diagnostic - ✔✔Dysuria, frequency, urgency, suprapubic pain, hematuria
Elderly-falls, AMS, change in functional status
Need UA-leukocyte esterase (pyuria), nitrites (enterobacter), WBCs, hematuria,
Culture
✔✔Treatment Complicated UTI - ✔✔Fever above 99.9, signs of sepsis
chills, rigors, marked fatigue, malaise
flank pain, CVA tenderness
✔✔UTI Treatment Low Risk - ✔✔Bactrim (trimethoprim/sulfamethaxazole) DS 160/800
mg BID x 3 days
Macrobid (Nitrofurantoin) 100 mg BID x 5 days
Alternatives:
Fosfomycin 3000 mg PO x 1 dose
Cipro 250 mg BID or ER 500 mg daily x 3 days
Levaquin 250 mg daily x 3 days
Augmentin 875 mg BID 5-7 days
Cephalexin 500 mg BID x 5-7 days
Cefdinir 300 mg BID 3-7 days
Pivmecillinam 400 mg BID 3-7 days
✔✔UTI Treatment Complicated - ✔✔After IV Doses
Cipro 500 mg -1000 mg ER once daily or Levaquin 750 mg daily 7-10 days
Bactrim DS BID 7-10 days
Macrobid 100 mg BID
✔✔Pyelonephritis Acute - ✔✔A diffuse infection of pelvis and kidney
acute invasion of bacteria to renal parenchyma
✔✔Pyelonephritis Chronic - ✔✔Develops slowly, usually assocated with obstruction
✔✔Acute Pyelo Symptoms - ✔✔Fever-not always present, but can be high
CVA Pain, usually unilateral, but can be bilateral
N/V
✔✔Pyelo Diagnosis - ✔✔UA-Leuk esterase +, nitrite production, hematuria, increased
pH, > 5 WBC
Urine Cx: > 100,000 cfu/ml
✔✔Pyelo Treatment - ✔✔Inpatient: Ceftriaxone 1 g IV daily, PO agent x 7 days
Cipro 500 mg PO BID or 400 mg IV BID x 7 days
Levofloxacin 750 mg PO or IV Daily x 7 days
, Last Line: Bactrim DS 1-2 tablets BID 10-14 days ONLY IF FLUROQUINOLONE IS
NOT AN OPTION
✔✔Urolithiasis - ✔✔Lifetime risk 8.8% in US, if you get one 50% risk of developing
another in 5-7 yrs
19% in men, 9% in women
causes-calcium oxalate or calcium phosphates, uric acid stones
✔✔Urolithiasis Symptoms - ✔✔severe pain to asymptomatic
colicky flank pain, unilateral radiating anteriorly to groin
urinary frequency/dysuria
hematuria
N/V
Fever/chills
Malodorous urine
✔✔Urolithiasis Diagnosis - ✔✔GOLD STANDARD-CT of Abd/Pelvis
Renal US
KUB Xray
UA/Urine Cx
Check certain minerals-calcium or uric acid
✔✔Urolithiasis Treatment Less than 5 mm - ✔✔less than 5 mm-pass on own-strain
urine to collect for analysis
oral hydration, analgesics
Severe pain-hospitalization
Uric acid stones may shrink and pass if using potassium citrate
✔✔Urolithiasis Treatment-Complicated - ✔✔Complete obstruction, large calculi, AKI,
Sepsis
Lithotripsy, stent placement, percutaneous stone extraction
✔✔Urolithiasis Prevention - ✔✔Hydration > 2 liters water daily
depending on type of stone-meds
thiazide diuretic or allopurinol, potassium citrate-uric acid
avoid high oxalate foods-spinach, almonds, soy, tea, cold cuts, legumes, beets
✔✔Incontinence (ALL) - ✔✔40% of women over 70 affected
risk factors: obesity, smoking w/ cough, diet-caffeiene, ETOH, fluid intake
✔✔Stress Incontinence - ✔✔urine leaks when bladder is under pressure, laughing,
coughing, increased abd pressure-vaginal deliveries
most common type
failure to store d/t hypermobility of bladder neck, intrinsic sphincter deficiency,
neurogenic sphincter deficiency
SOLUTIONS RATED A+
✔✔UTI Diagnostic - ✔✔Dysuria, frequency, urgency, suprapubic pain, hematuria
Elderly-falls, AMS, change in functional status
Need UA-leukocyte esterase (pyuria), nitrites (enterobacter), WBCs, hematuria,
Culture
✔✔Treatment Complicated UTI - ✔✔Fever above 99.9, signs of sepsis
chills, rigors, marked fatigue, malaise
flank pain, CVA tenderness
✔✔UTI Treatment Low Risk - ✔✔Bactrim (trimethoprim/sulfamethaxazole) DS 160/800
mg BID x 3 days
Macrobid (Nitrofurantoin) 100 mg BID x 5 days
Alternatives:
Fosfomycin 3000 mg PO x 1 dose
Cipro 250 mg BID or ER 500 mg daily x 3 days
Levaquin 250 mg daily x 3 days
Augmentin 875 mg BID 5-7 days
Cephalexin 500 mg BID x 5-7 days
Cefdinir 300 mg BID 3-7 days
Pivmecillinam 400 mg BID 3-7 days
✔✔UTI Treatment Complicated - ✔✔After IV Doses
Cipro 500 mg -1000 mg ER once daily or Levaquin 750 mg daily 7-10 days
Bactrim DS BID 7-10 days
Macrobid 100 mg BID
✔✔Pyelonephritis Acute - ✔✔A diffuse infection of pelvis and kidney
acute invasion of bacteria to renal parenchyma
✔✔Pyelonephritis Chronic - ✔✔Develops slowly, usually assocated with obstruction
✔✔Acute Pyelo Symptoms - ✔✔Fever-not always present, but can be high
CVA Pain, usually unilateral, but can be bilateral
N/V
✔✔Pyelo Diagnosis - ✔✔UA-Leuk esterase +, nitrite production, hematuria, increased
pH, > 5 WBC
Urine Cx: > 100,000 cfu/ml
✔✔Pyelo Treatment - ✔✔Inpatient: Ceftriaxone 1 g IV daily, PO agent x 7 days
Cipro 500 mg PO BID or 400 mg IV BID x 7 days
Levofloxacin 750 mg PO or IV Daily x 7 days
, Last Line: Bactrim DS 1-2 tablets BID 10-14 days ONLY IF FLUROQUINOLONE IS
NOT AN OPTION
✔✔Urolithiasis - ✔✔Lifetime risk 8.8% in US, if you get one 50% risk of developing
another in 5-7 yrs
19% in men, 9% in women
causes-calcium oxalate or calcium phosphates, uric acid stones
✔✔Urolithiasis Symptoms - ✔✔severe pain to asymptomatic
colicky flank pain, unilateral radiating anteriorly to groin
urinary frequency/dysuria
hematuria
N/V
Fever/chills
Malodorous urine
✔✔Urolithiasis Diagnosis - ✔✔GOLD STANDARD-CT of Abd/Pelvis
Renal US
KUB Xray
UA/Urine Cx
Check certain minerals-calcium or uric acid
✔✔Urolithiasis Treatment Less than 5 mm - ✔✔less than 5 mm-pass on own-strain
urine to collect for analysis
oral hydration, analgesics
Severe pain-hospitalization
Uric acid stones may shrink and pass if using potassium citrate
✔✔Urolithiasis Treatment-Complicated - ✔✔Complete obstruction, large calculi, AKI,
Sepsis
Lithotripsy, stent placement, percutaneous stone extraction
✔✔Urolithiasis Prevention - ✔✔Hydration > 2 liters water daily
depending on type of stone-meds
thiazide diuretic or allopurinol, potassium citrate-uric acid
avoid high oxalate foods-spinach, almonds, soy, tea, cold cuts, legumes, beets
✔✔Incontinence (ALL) - ✔✔40% of women over 70 affected
risk factors: obesity, smoking w/ cough, diet-caffeiene, ETOH, fluid intake
✔✔Stress Incontinence - ✔✔urine leaks when bladder is under pressure, laughing,
coughing, increased abd pressure-vaginal deliveries
most common type
failure to store d/t hypermobility of bladder neck, intrinsic sphincter deficiency,
neurogenic sphincter deficiency
