NP CERTIFICATION — CLINICAL NOTES
NURS 5433 NP Certification Examination & Practice
Preparation Exam Questions
Comprehensive Reference: Renal • Skin • Endocrine • Respiratory • ENT
• Ophthalmology
SECTION 1 — RENAL / UROLOGICAL DISORDERS
Renal & Urological Disorders
Acute Kidney Injury (AKI)
AKI — Clinical Reference
Definition Abrupt decline in renal function (↑Cr ≥0.3 mg/dL within 48h OR ≥1.5x baseline within 7d,
OR UO <0.5 mL/kg/h for ≥6h)
Classification Prerenal (most common, ~60%): ↓perfusion (dehydration, HF, hemorrhage, sepsis,
NSAIDs, ACEIs with bilateral RAS). Intrinsic: ATN, glomerulonephritis, interstitial nephritis.
Postrenal: obstruction (BPH, stones, tumor)
Lab Patterns Prerenal: BUN:Cr >20:1, FeNa <1%, concentrated urine. ATN: BUN:Cr <20:1, FeNa >2%,
granular casts. GN: RBC casts, proteinuria, BUN:Cr <20:1. Postrenal: hydronephrosis on US
Key Electrolytes Hyperkalemia (most dangerous), hyperphosphatemia, metabolic acidosis, hypercalcemia.
NOT hypophosphatemia or hypokalemia
Treatment Treat underlying cause; fluid resuscitation for prerenal; remove nephrotoxins; relieve
obstruction; avoid contrast dye; hold ACEIs/ARBs/NSAIDs; monitor K⁺
Dialysis Indications AEIOU: Acidosis, Electrolytes (K >6.5), Intoxication, fluid Overload, Uremia ⁺ symptoms
(pericarditis, encephalopathy, Cr >10)
Acute Pyelonephritis
Acute Pyelonephritis
Definition Upper UTI involving renal parenchyma and pelvis; ascending infection from bladder
Presentation Fever (>38°C), chills, flank pain, CVA tenderness, nausea/vomiting, lower UTI symptoms
(dysuria, frequency). Elderly: may present atypically (confusion, weakness, no classic UTI
sx)
Lab Findings UA: pyuria, bacteriuria, WBC casts (pathognomonic for pyelonephritis), positive leukocyte
esterase/nitrites. CBC: leukocytosis, bandemia, neutrophilia. Blood cultures if septic.
Causative Agents E. coli (most common), Klebsiella, Proteus, Enterococcus
, Imaging Not routinely needed for uncomplicated cases. CT/US if: no improvement in 72h,
suspected abscess, calculi, or complicated disease
Outpatient Tx Ciprofloxacin 500mg BID x7d (preferred) OR levofloxacin 750mg QD x5d. Alt: TMP-SMX DS
BID x14d. NOT nitrofurantoin (inadequate tissue levels)
Inpatient Indications Sepsis, inability to tolerate oral intake, pregnancy, immunocompromised, failed
outpatient therapy, urologic anomaly
Inpatient Tx IV ceftriaxone OR ciprofloxacin; transition to oral when afebrile x48h
Albuminuria & Diabetic Nephropathy
Albuminuria / Diabetic Nephropathy
Albuminuria Staging Normal: <30 mg/g Cr. Microalbuminuria (A2): 30–299 mg/g. Macroalbuminuria
(A3): ≥300 mg/g. Check annually in DM patients. First sign of diabetic nephropathy.
Diabetic Most common cause of ESRD in US. Hyperfiltration → glomerular hypertrophy →
Nephropathy microalbuminuria → overt nephropathy → ESRD. Occurs ~10-15 yrs after DM diagnosis
Monitoring Urine albumin:creatinine ratio (ACR) annually. Serum Cr + eGFR annually. More frequent if
A2/A3 or declining eGFR
Treatment ACEI or ARB: first-line (reduces efferent arteriolar resistance → ↓ intraglomerular
pressure → slows progression). Do NOT combine ACEI + ARB. SGLT2 inhibitors
(canagliflozin, dapagliflozin) have renal-protective effects
BP Goal <130/80 mmHg in DM with proteinuria. ACEI/ARB preferred antihypertensive class
Progression Prevention Tight glycemic control (A1c ≤7%), BP control, dyslipidemia treatment, smoking cessation,
low-protein diet (0.8 g/kg/day in CKD)
Asymptomatic Bacteriuria (ASB)
Asymptomatic Bacteriuria
Definition ≥10⁵ CFU/mL of a uropathogen on 2 consecutive specimens (women) or 1 specimen
(men) WITHOUT UTI symptoms
Treat ASB Pregnancy (screening 12-16 wks; treat to prevent preterm birth/pyelonephritis) | Prior to
urological procedures with mucosal trauma
Do NOT Treat Elderly (most common population with ASB — treating increases resistance, C. diff risk
without benefit) | DM | Catheterized patients | Pre-op (except urological) | Healthy non-
pregnant women
Key Exam Fact USPSTF: Screen pregnant women at 12-16 weeks with urine culture. Routine screening
NOT recommended in non-pregnant adults including elderly, DM, catheterized patients
Treatment if Indicated Nitrofurantoin x5-7d OR amoxicillin x3-7d OR cephalosporin x3-7d (based on sensitivity in
pregnancy). Avoid fluoroquinolones in pregnancy
, Glomerulonephritis & Post-Streptococcal GN
Glomerulonephritis (GN)
Definition Inflammation of the glomeruli → impaired filtration → protein and RBC leak into urine
Nephritic Syndrome Hematuria + RBC casts + proteinuria + HTN + ↓GFR + edema. Caused by: poststrep GN,
IgA nephropathy (Berger disease), lupus nephritis, Goodpasture syndrome
Nephrotic Syndrome Massive proteinuria (>3.5g/day) + hypoalbuminemia + edema + hyperlipidemia + lipiduria.
Caused by: minimal change disease (children), FSGS, membranous nephropathy, diabetic
nephropathy
Post-Streptococcal Occurs 1-2 weeks after GABHS pharyngitis OR 3-4 weeks after strep skin
GN infection. Immune complex deposition. Typically self-limiting in children. Hematuria ("cola-
colored urine"), oliguria, HTN, edema, proteinuria
Diagnosis UA: RBCs, RBC casts, proteinuria, WBCs. Serum: ↑BUN, ↑Cr, ↓complement (C3, C4). ASO
titer ↑ in post-strep GN. Kidney biopsy for definitive diagnosis
Treatment Post-strep GN: supportive (antihypertensives, fluid/salt restriction). Other GN:
steroids, immunosuppressants, plasmapheresis (for Goodpasture). NOT antimicrobials for
post-strep GN (strep already cleared)
Complications HTN, nephrotic syndrome, CKD, ESRD
Hematuria
Hematuria
Definition Gross hematuria: visible blood. Microscopic hematuria: ≥3 RBCs/HPF on 2 of 3 properly
collected specimens
Causes Glomerular: RBC casts, proteinuria → GN, Berger disease, Alport syndrome.
Nonglomerular: UTI (most common), stones, tumor, BPH, trauma, polycystic kidney
disease, medications (cyclophosphamide)
Evaluation UA with microscopy, urine culture, CBC, BMP, urine cytology. Cystoscopy + imaging (CT
urogram) if: age ≥35, smoking hx, risk factors for bladder cancer, persistent microscopic
hematuria
Red Flags Gross painless hematuria = bladder cancer until proven otherwise. Persistent microscopic
hematuria in 20% of bladder cancer cases
False Positive Myoglobinuria (rhabdomyolysis), hemoglobinuria, beet/berry ingestion, rifampin,
Hematuria phenazopyridine → dipstick positive but no RBCs on microscopy
Renal Insufficiency / Chronic Kidney Disease (CKD)
CKD Staging & Management
NURS 5433 NP Certification Examination & Practice
Preparation Exam Questions
Comprehensive Reference: Renal • Skin • Endocrine • Respiratory • ENT
• Ophthalmology
SECTION 1 — RENAL / UROLOGICAL DISORDERS
Renal & Urological Disorders
Acute Kidney Injury (AKI)
AKI — Clinical Reference
Definition Abrupt decline in renal function (↑Cr ≥0.3 mg/dL within 48h OR ≥1.5x baseline within 7d,
OR UO <0.5 mL/kg/h for ≥6h)
Classification Prerenal (most common, ~60%): ↓perfusion (dehydration, HF, hemorrhage, sepsis,
NSAIDs, ACEIs with bilateral RAS). Intrinsic: ATN, glomerulonephritis, interstitial nephritis.
Postrenal: obstruction (BPH, stones, tumor)
Lab Patterns Prerenal: BUN:Cr >20:1, FeNa <1%, concentrated urine. ATN: BUN:Cr <20:1, FeNa >2%,
granular casts. GN: RBC casts, proteinuria, BUN:Cr <20:1. Postrenal: hydronephrosis on US
Key Electrolytes Hyperkalemia (most dangerous), hyperphosphatemia, metabolic acidosis, hypercalcemia.
NOT hypophosphatemia or hypokalemia
Treatment Treat underlying cause; fluid resuscitation for prerenal; remove nephrotoxins; relieve
obstruction; avoid contrast dye; hold ACEIs/ARBs/NSAIDs; monitor K⁺
Dialysis Indications AEIOU: Acidosis, Electrolytes (K >6.5), Intoxication, fluid Overload, Uremia ⁺ symptoms
(pericarditis, encephalopathy, Cr >10)
Acute Pyelonephritis
Acute Pyelonephritis
Definition Upper UTI involving renal parenchyma and pelvis; ascending infection from bladder
Presentation Fever (>38°C), chills, flank pain, CVA tenderness, nausea/vomiting, lower UTI symptoms
(dysuria, frequency). Elderly: may present atypically (confusion, weakness, no classic UTI
sx)
Lab Findings UA: pyuria, bacteriuria, WBC casts (pathognomonic for pyelonephritis), positive leukocyte
esterase/nitrites. CBC: leukocytosis, bandemia, neutrophilia. Blood cultures if septic.
Causative Agents E. coli (most common), Klebsiella, Proteus, Enterococcus
, Imaging Not routinely needed for uncomplicated cases. CT/US if: no improvement in 72h,
suspected abscess, calculi, or complicated disease
Outpatient Tx Ciprofloxacin 500mg BID x7d (preferred) OR levofloxacin 750mg QD x5d. Alt: TMP-SMX DS
BID x14d. NOT nitrofurantoin (inadequate tissue levels)
Inpatient Indications Sepsis, inability to tolerate oral intake, pregnancy, immunocompromised, failed
outpatient therapy, urologic anomaly
Inpatient Tx IV ceftriaxone OR ciprofloxacin; transition to oral when afebrile x48h
Albuminuria & Diabetic Nephropathy
Albuminuria / Diabetic Nephropathy
Albuminuria Staging Normal: <30 mg/g Cr. Microalbuminuria (A2): 30–299 mg/g. Macroalbuminuria
(A3): ≥300 mg/g. Check annually in DM patients. First sign of diabetic nephropathy.
Diabetic Most common cause of ESRD in US. Hyperfiltration → glomerular hypertrophy →
Nephropathy microalbuminuria → overt nephropathy → ESRD. Occurs ~10-15 yrs after DM diagnosis
Monitoring Urine albumin:creatinine ratio (ACR) annually. Serum Cr + eGFR annually. More frequent if
A2/A3 or declining eGFR
Treatment ACEI or ARB: first-line (reduces efferent arteriolar resistance → ↓ intraglomerular
pressure → slows progression). Do NOT combine ACEI + ARB. SGLT2 inhibitors
(canagliflozin, dapagliflozin) have renal-protective effects
BP Goal <130/80 mmHg in DM with proteinuria. ACEI/ARB preferred antihypertensive class
Progression Prevention Tight glycemic control (A1c ≤7%), BP control, dyslipidemia treatment, smoking cessation,
low-protein diet (0.8 g/kg/day in CKD)
Asymptomatic Bacteriuria (ASB)
Asymptomatic Bacteriuria
Definition ≥10⁵ CFU/mL of a uropathogen on 2 consecutive specimens (women) or 1 specimen
(men) WITHOUT UTI symptoms
Treat ASB Pregnancy (screening 12-16 wks; treat to prevent preterm birth/pyelonephritis) | Prior to
urological procedures with mucosal trauma
Do NOT Treat Elderly (most common population with ASB — treating increases resistance, C. diff risk
without benefit) | DM | Catheterized patients | Pre-op (except urological) | Healthy non-
pregnant women
Key Exam Fact USPSTF: Screen pregnant women at 12-16 weeks with urine culture. Routine screening
NOT recommended in non-pregnant adults including elderly, DM, catheterized patients
Treatment if Indicated Nitrofurantoin x5-7d OR amoxicillin x3-7d OR cephalosporin x3-7d (based on sensitivity in
pregnancy). Avoid fluoroquinolones in pregnancy
, Glomerulonephritis & Post-Streptococcal GN
Glomerulonephritis (GN)
Definition Inflammation of the glomeruli → impaired filtration → protein and RBC leak into urine
Nephritic Syndrome Hematuria + RBC casts + proteinuria + HTN + ↓GFR + edema. Caused by: poststrep GN,
IgA nephropathy (Berger disease), lupus nephritis, Goodpasture syndrome
Nephrotic Syndrome Massive proteinuria (>3.5g/day) + hypoalbuminemia + edema + hyperlipidemia + lipiduria.
Caused by: minimal change disease (children), FSGS, membranous nephropathy, diabetic
nephropathy
Post-Streptococcal Occurs 1-2 weeks after GABHS pharyngitis OR 3-4 weeks after strep skin
GN infection. Immune complex deposition. Typically self-limiting in children. Hematuria ("cola-
colored urine"), oliguria, HTN, edema, proteinuria
Diagnosis UA: RBCs, RBC casts, proteinuria, WBCs. Serum: ↑BUN, ↑Cr, ↓complement (C3, C4). ASO
titer ↑ in post-strep GN. Kidney biopsy for definitive diagnosis
Treatment Post-strep GN: supportive (antihypertensives, fluid/salt restriction). Other GN:
steroids, immunosuppressants, plasmapheresis (for Goodpasture). NOT antimicrobials for
post-strep GN (strep already cleared)
Complications HTN, nephrotic syndrome, CKD, ESRD
Hematuria
Hematuria
Definition Gross hematuria: visible blood. Microscopic hematuria: ≥3 RBCs/HPF on 2 of 3 properly
collected specimens
Causes Glomerular: RBC casts, proteinuria → GN, Berger disease, Alport syndrome.
Nonglomerular: UTI (most common), stones, tumor, BPH, trauma, polycystic kidney
disease, medications (cyclophosphamide)
Evaluation UA with microscopy, urine culture, CBC, BMP, urine cytology. Cystoscopy + imaging (CT
urogram) if: age ≥35, smoking hx, risk factors for bladder cancer, persistent microscopic
hematuria
Red Flags Gross painless hematuria = bladder cancer until proven otherwise. Persistent microscopic
hematuria in 20% of bladder cancer cases
False Positive Myoglobinuria (rhabdomyolysis), hemoglobinuria, beet/berry ingestion, rifampin,
Hematuria phenazopyridine → dipstick positive but no RBCs on microscopy
Renal Insufficiency / Chronic Kidney Disease (CKD)
CKD Staging & Management
