NURS620 EXAM 3 | COMPLETE QUESTIONS WITH EXPERT
SOLUTION | 2026 LATEST UPDATED GET A+
Q1. A 24-year-old woman reports 2 days of burning with urination, frequency, and urgency. No
fever, flank pain, or vaginal discharge. Urine dip: + leukocyte esterase, + nitrites. What is the
most appropriate first-line treatment?
A) Ciprofloxacin
B) Nitrofurantoin (Macrobid)
C) Amoxicillin
D) Doxycycline - (Answer)B) Nitrofurantoin (Macrobid). First-line for uncomplicated cystitis
due to low E. coli resistance; fluoroquinolones are reserved for complicated UTIs, and
amoxicillin/doxycycline are not preferred.
Dysuria — definition - (Answer)Subjective painful/burning urination; may include frequency,
hesitancy, urgency, and strangury (slow, painful urination). Most often a BLADDER (lower UTI)
problem, not renal.
Strangury - (Answer)Slow, painful urination — a component of dysuria.
Dysuria — most common cause - (Answer)Lower urinary tract infection (cystitis/urethritis).
,Q2. A 45-year-old man presents with dysuria and frequency. Urine culture confirms E. coli. How
should this be treated?
A) Single-dose fosfomycin
B) 3-day nitrofurantoin
C) At least 7 days of antibiotics — treat as complicated
D) Symptomatic care only - (Answer)C) At least 7 days — treat as complicated. ANY UTI in a
male is considered complicated; avoid short courses. Nitrofurantoin/beta-lactams are avoided for
complicated UTIs.
Meds that cause dysuria - (Answer)SSRIs (citalopram, escitalopram, paroxetine, fluoxetine,
sertraline); anticholinergics — opiates, scopolamine.
Painless hematuria — key concern - (Answer)BLADDER CANCER. Painless gross hematuria is
a cardinal sign — always rule out malignancy.
Q3. A 30-year-old woman has fever of 103°F, right costovertebral angle tenderness, and
nausea/vomiting. UA shows WBC casts, nitrites, and bacteria. What is the most likely diagnosis?
A) Cystitis
B) Nephrolithiasis
C) Pyelonephritis
,D) Interstitial cystitis - (Answer)C) Pyelonephritis. Classic triad = fever + CVA pain + N/V.
WBC casts point to kidney involvement and help distinguish pyelo from cystitis.
Types of hematuria - (Answer)Isolated (blood only), bacterial + hematuria (infection:
UTI/cystitis/urethritis), proteinuria + hematuria (glomerular/interstitial nephritis), and med/food-
related (pseudo-hematuria).
Red/orange urine from foods & meds - (Answer)Beets (reddish), rifampin & Pyridium (red-
orange), hemoglobin/myoglobin (reddish-brown). Take a good diet/med history before calling it
hematuria.
Exercise-related hematuria - (Answer)~18% of high-activity patients (e.g., long-distance
runners) — from repetitive kidney vibration. Take an activity history.
Q4. The patient in Q3 has persistent vomiting and cannot keep fluids down. What is the best next
step?
A) Oral Bactrim DS at home
B) Hospitalize for IV antibiotics
C) Reassure and recheck in 1 week
, D) Start Pyridium only - (Answer)B) Hospitalize for IV antibiotics. N/V or signs of sepsis
warrant admission; outpatients who fail to improve in 48h also need reevaluation and imaging.
Gross vs microscopic hematuria & malignancy - (Answer)Positive correlation of malignancy
with GROSS hematuria (higher risk than microscopic); risk rises with cigarette smoking.
Geriatric hematuria malignancy rates - (Answer)Men >50 with hematuria: 2.4% have urinary
malignancy (often transitional cell). >60 yrs: ~9%. Older males with GROSS hematuria: up to
20%.
Q5. A 38-year-old man has sudden severe left flank pain radiating to the groin, with nausea and
gross hematuria. He is writhing and cannot find a comfortable position. What is the most likely
diagnosis?
A) Pyelonephritis
B) Nephrolithiasis
C) Prostatitis
D) Bladder cancer - (Answer)B) Nephrolithiasis. Sudden colicky flank pain radiating to groin
with hematuria is the cardinal presentation. Colicky flank pain favors stones; CVA tenderness
favors pyelonephritis.
SOLUTION | 2026 LATEST UPDATED GET A+
Q1. A 24-year-old woman reports 2 days of burning with urination, frequency, and urgency. No
fever, flank pain, or vaginal discharge. Urine dip: + leukocyte esterase, + nitrites. What is the
most appropriate first-line treatment?
A) Ciprofloxacin
B) Nitrofurantoin (Macrobid)
C) Amoxicillin
D) Doxycycline - (Answer)B) Nitrofurantoin (Macrobid). First-line for uncomplicated cystitis
due to low E. coli resistance; fluoroquinolones are reserved for complicated UTIs, and
amoxicillin/doxycycline are not preferred.
Dysuria — definition - (Answer)Subjective painful/burning urination; may include frequency,
hesitancy, urgency, and strangury (slow, painful urination). Most often a BLADDER (lower UTI)
problem, not renal.
Strangury - (Answer)Slow, painful urination — a component of dysuria.
Dysuria — most common cause - (Answer)Lower urinary tract infection (cystitis/urethritis).
,Q2. A 45-year-old man presents with dysuria and frequency. Urine culture confirms E. coli. How
should this be treated?
A) Single-dose fosfomycin
B) 3-day nitrofurantoin
C) At least 7 days of antibiotics — treat as complicated
D) Symptomatic care only - (Answer)C) At least 7 days — treat as complicated. ANY UTI in a
male is considered complicated; avoid short courses. Nitrofurantoin/beta-lactams are avoided for
complicated UTIs.
Meds that cause dysuria - (Answer)SSRIs (citalopram, escitalopram, paroxetine, fluoxetine,
sertraline); anticholinergics — opiates, scopolamine.
Painless hematuria — key concern - (Answer)BLADDER CANCER. Painless gross hematuria is
a cardinal sign — always rule out malignancy.
Q3. A 30-year-old woman has fever of 103°F, right costovertebral angle tenderness, and
nausea/vomiting. UA shows WBC casts, nitrites, and bacteria. What is the most likely diagnosis?
A) Cystitis
B) Nephrolithiasis
C) Pyelonephritis
,D) Interstitial cystitis - (Answer)C) Pyelonephritis. Classic triad = fever + CVA pain + N/V.
WBC casts point to kidney involvement and help distinguish pyelo from cystitis.
Types of hematuria - (Answer)Isolated (blood only), bacterial + hematuria (infection:
UTI/cystitis/urethritis), proteinuria + hematuria (glomerular/interstitial nephritis), and med/food-
related (pseudo-hematuria).
Red/orange urine from foods & meds - (Answer)Beets (reddish), rifampin & Pyridium (red-
orange), hemoglobin/myoglobin (reddish-brown). Take a good diet/med history before calling it
hematuria.
Exercise-related hematuria - (Answer)~18% of high-activity patients (e.g., long-distance
runners) — from repetitive kidney vibration. Take an activity history.
Q4. The patient in Q3 has persistent vomiting and cannot keep fluids down. What is the best next
step?
A) Oral Bactrim DS at home
B) Hospitalize for IV antibiotics
C) Reassure and recheck in 1 week
, D) Start Pyridium only - (Answer)B) Hospitalize for IV antibiotics. N/V or signs of sepsis
warrant admission; outpatients who fail to improve in 48h also need reevaluation and imaging.
Gross vs microscopic hematuria & malignancy - (Answer)Positive correlation of malignancy
with GROSS hematuria (higher risk than microscopic); risk rises with cigarette smoking.
Geriatric hematuria malignancy rates - (Answer)Men >50 with hematuria: 2.4% have urinary
malignancy (often transitional cell). >60 yrs: ~9%. Older males with GROSS hematuria: up to
20%.
Q5. A 38-year-old man has sudden severe left flank pain radiating to the groin, with nausea and
gross hematuria. He is writhing and cannot find a comfortable position. What is the most likely
diagnosis?
A) Pyelonephritis
B) Nephrolithiasis
C) Prostatitis
D) Bladder cancer - (Answer)B) Nephrolithiasis. Sudden colicky flank pain radiating to groin
with hematuria is the cardinal presentation. Colicky flank pain favors stones; CVA tenderness
favors pyelonephritis.
