NR 507 Pathophysiology Final Exam –
Comprehensive Practice Questions, Detailed
Explanations, and Exam Preparation Guide
Renal Sy stem ...
Urinary Tract pre-quiz Q's ....
1. What are the two main functions of the 1. Filtration and collection
kidney Review diagram for anatomical
structures
Women are at a higher risk for the True
development of a UTI because of having a
shorter urethra. True/False
,Which of the following can help to prevent a Increase water consumption
UTI?
Increase water consumption
Use spermicides during sexual intercourse
Taking more Vitamin D
Douching to prevent the growth of bacteria
A symptom of a lower urinary tract infection Urgency
includes:
Fever
Flank pain
Urgency
Decreased Urination
Which of the following is true regarding a Can be caused by a structural urinary tract disorder
complicated urinary tract infection?
It is usually asymptomatic
Can be caused by a structural urinary tract
disorder
Bacteria are located mostly in the lower
urinary tract
Is associated with young adults
Which of the following is a risk factor for the Pregnancy
development of a urinary tract infection
(UTI)?
Perimenopause
Frequent showering
Marathon running
Pregnancy
1. Where do bacteria commonly 1. Bacteria from the gut can invade the urinary
come from in UTI's epithelium to cause inflammation and infection
2.Where can a UTI occur? 2.anywhere along the urinary tract such as the
3.It is more common for women to develop urethra, bladder, ureter, or kidney
a UTI especially when 3. pregnant, sexually active, during post-menopause with
estrogen-deficiency and when being treated with antibiotics
where the normal bacteria flora is diminished
,1. Escherichia coli can bind to cells 1. A biofilm is any group of microorganisms that allow
in the lower urinary tract and hide them to stick to one another and adhere to surfaces that
from the immune cells. The bacteria help them survive.
can form biofilms-what is this? 2.First, bacteria enter and contaminate the lower urinary tract.
2.Describe the pathophysiology of a This causes the colonization of bacteria in the urethra and
UTI that can lead to septic shock or the bladder. If the UTI progresses the bacteria can ascend to
bacterimia Note the diagram btw a the kidneys and colonize there. At this point, the infection
male & female urinary tracts (who's is becomes an upper UTI. From there, if left untreated, the
much shorter) bacteria can spread into the circulation via the renal veins
causing bacteremia
UTI risk factors 1. During pregnancy, progesterone relaxes smooth
1. For women, pregnancy is a risk muscle that causes stasis of urine, allowing the bacteria to
factor. why? colonize
2. The female ureter is shorter and 2.allows for the entrance of bacteria into the urethra.
3.Post-menopausal women are also at 3.lack of estrogen results in vaginal and urethral
risk because dryness promoting an environment for bacteria
4. Sexual intercourse is a risk factor growth.
especially if women use 4. spermicides
5. Indwelling urinary catheterization is also 5.Fibrinogen accumulates on the catheter which provides
a major cause of a UTI an ideal environment for the attachment of uropathogens
that then form biofilms. This results in epithelial damage
Lower vs. Upper Tract Disorders 1. urethra (urethritis) or bladder (cystitis). In males, the
1. Lower UTI's include what parts cystitis may be associated with prostatitis.
of the urinary tract 2.urgency associated with burning on urination.
2.In a lower urinary tract disorder, the frequency, dysuria, and suprapubic pain. The urine may
individual experiences (blank) also appear cloudy and have an odor.
Other common symptoms include 3.is highly specific for bacterial infection
3.initially, a urine dipstick can be 4. culture and sensitivity (C&S) test and microscopy
performed to identify hematuria, 5.a white blood cell (WBC) count of greater than 5000 high
proteinuria, and the presence of nitrites. power field (hpf) and hematuria
The presence of nitrites
4. an individual can have a negative
urine dipstick but still have a UTI. If this is the
case, then the NP can send the urine for
a
5.On microscopic exam of the urine, a
patient with cystitis will have
1. An infection of the lower urinary 1. pyelonephritis.
tract can progress to an upper urinary 2.all the symptoms associated with cystitis plus fever, flank
tract infection if the bacteria ascends from pain, costovertebral angle (CVA) tenderness, nausea, and
the bladder to the kidney. The condition vomiting. Malaise is also a common complaint
is 3.vomiting, flank pain and fever
2. The signs and symptoms of 4. there can also be signs of shock
pyelonephritis include 5.WBC casts
3.Think of the symptoms of pyelonephritis
in a classic triad:
4. if the infection has entered the
circulation from the kidney via the renal
vein
5. For the patient with pyelonephritis, the
urine will present with
, Uncomplicated vs. Complicated Urinary 1. renal function is normal, urine results may confirm a UTI,
Tract Infections (UTI) but the patient denies symptoms, no antibiotic is
1. A UTI may be classified as prescribed
complicated or uncomplicated in terms of 2.renal function and an abnormality in the renal tract
its severity. An uncomplicated UTI
indicates that
2.In a complicated UTI, there is decreased
Un-Complicated UTI 1. the normal urinary tract
1. Occurs in the normal urinary tract 2.a short course of antibiotic therapy
2.Responds well to 3.non-pregnant women without any urologic abnormalities
3.Ie: Simple cystitis in 4. the bladder
Complicated UTI 5. structural or functional urinary tract abnormalities
4.A UTI that extends beyond or untreated UTI
5.Caused by 6.pregnant mothers & older adults affected
6.Infants and 7. indwelling catheters, renal calculi, diabetes, pregnancy
7. Associated with:
1. The most common organisms that 1. Escherichia coli (80% of cases),
cause a UTI is Staphylococcus saprophyticus, Proteus
2. A urinalysis is used to diagnose a Mirabilis, and Klebsiella.
UTI. If nitrites are present, this 2.the causative organism is gram negative
indicates 3.100,000 colony forming units/ml. remember a UTI occurs
3.A urine culture may also be performed to when bacteria colonize, cling to the bladder well, form
determine infection. A positive culture biofilms and overwhelm the immune system
indicates that there are greater than
Using the Urinalysis to Diagnose a Urinary 1. the case of Enterococcus bacteria
Tract Infection 2.the highest positive predictive value.
1. some bacteria are unable to Complicated
produce nitrites. this would be Protein + or –
2. The presence of nitrites is Leukocyte Esterase +
the most specific finding and has Nitrites + or –
Differentiate between the UA of a RBCs +
complicated and uncomplicated UTI WBCs + > 100,000/hpf
Protein Casts +
Leukocyte Esterase Uncomplicated
Nitrites Protein + or –
RBCs Leukocyte Esterase +
WBCs Nitrites + or –
Casts RBCs + or –
WBCs + > 5000/hpf
Casts None
Remember a for a dx of UTI the pt needs to be presenting
with symptoms
Casts: are long cylindrical structures 1. acute tubular necrosis
formed in the renal tubules due to the 2.acute and chronic renal failure.
precipitation of Tamm-Horsfall 3.nephrotic syndrome
mucoprotein 4. glomerulonephritis
1. Muddy brown casts suggest 5. interstitial inflammation
2.Waxy casts are suggestive of
3.Fatty casts are suggestive of
4. RBC casts suggest
5.WBC casts suggest
Comprehensive Practice Questions, Detailed
Explanations, and Exam Preparation Guide
Renal Sy stem ...
Urinary Tract pre-quiz Q's ....
1. What are the two main functions of the 1. Filtration and collection
kidney Review diagram for anatomical
structures
Women are at a higher risk for the True
development of a UTI because of having a
shorter urethra. True/False
,Which of the following can help to prevent a Increase water consumption
UTI?
Increase water consumption
Use spermicides during sexual intercourse
Taking more Vitamin D
Douching to prevent the growth of bacteria
A symptom of a lower urinary tract infection Urgency
includes:
Fever
Flank pain
Urgency
Decreased Urination
Which of the following is true regarding a Can be caused by a structural urinary tract disorder
complicated urinary tract infection?
It is usually asymptomatic
Can be caused by a structural urinary tract
disorder
Bacteria are located mostly in the lower
urinary tract
Is associated with young adults
Which of the following is a risk factor for the Pregnancy
development of a urinary tract infection
(UTI)?
Perimenopause
Frequent showering
Marathon running
Pregnancy
1. Where do bacteria commonly 1. Bacteria from the gut can invade the urinary
come from in UTI's epithelium to cause inflammation and infection
2.Where can a UTI occur? 2.anywhere along the urinary tract such as the
3.It is more common for women to develop urethra, bladder, ureter, or kidney
a UTI especially when 3. pregnant, sexually active, during post-menopause with
estrogen-deficiency and when being treated with antibiotics
where the normal bacteria flora is diminished
,1. Escherichia coli can bind to cells 1. A biofilm is any group of microorganisms that allow
in the lower urinary tract and hide them to stick to one another and adhere to surfaces that
from the immune cells. The bacteria help them survive.
can form biofilms-what is this? 2.First, bacteria enter and contaminate the lower urinary tract.
2.Describe the pathophysiology of a This causes the colonization of bacteria in the urethra and
UTI that can lead to septic shock or the bladder. If the UTI progresses the bacteria can ascend to
bacterimia Note the diagram btw a the kidneys and colonize there. At this point, the infection
male & female urinary tracts (who's is becomes an upper UTI. From there, if left untreated, the
much shorter) bacteria can spread into the circulation via the renal veins
causing bacteremia
UTI risk factors 1. During pregnancy, progesterone relaxes smooth
1. For women, pregnancy is a risk muscle that causes stasis of urine, allowing the bacteria to
factor. why? colonize
2. The female ureter is shorter and 2.allows for the entrance of bacteria into the urethra.
3.Post-menopausal women are also at 3.lack of estrogen results in vaginal and urethral
risk because dryness promoting an environment for bacteria
4. Sexual intercourse is a risk factor growth.
especially if women use 4. spermicides
5. Indwelling urinary catheterization is also 5.Fibrinogen accumulates on the catheter which provides
a major cause of a UTI an ideal environment for the attachment of uropathogens
that then form biofilms. This results in epithelial damage
Lower vs. Upper Tract Disorders 1. urethra (urethritis) or bladder (cystitis). In males, the
1. Lower UTI's include what parts cystitis may be associated with prostatitis.
of the urinary tract 2.urgency associated with burning on urination.
2.In a lower urinary tract disorder, the frequency, dysuria, and suprapubic pain. The urine may
individual experiences (blank) also appear cloudy and have an odor.
Other common symptoms include 3.is highly specific for bacterial infection
3.initially, a urine dipstick can be 4. culture and sensitivity (C&S) test and microscopy
performed to identify hematuria, 5.a white blood cell (WBC) count of greater than 5000 high
proteinuria, and the presence of nitrites. power field (hpf) and hematuria
The presence of nitrites
4. an individual can have a negative
urine dipstick but still have a UTI. If this is the
case, then the NP can send the urine for
a
5.On microscopic exam of the urine, a
patient with cystitis will have
1. An infection of the lower urinary 1. pyelonephritis.
tract can progress to an upper urinary 2.all the symptoms associated with cystitis plus fever, flank
tract infection if the bacteria ascends from pain, costovertebral angle (CVA) tenderness, nausea, and
the bladder to the kidney. The condition vomiting. Malaise is also a common complaint
is 3.vomiting, flank pain and fever
2. The signs and symptoms of 4. there can also be signs of shock
pyelonephritis include 5.WBC casts
3.Think of the symptoms of pyelonephritis
in a classic triad:
4. if the infection has entered the
circulation from the kidney via the renal
vein
5. For the patient with pyelonephritis, the
urine will present with
, Uncomplicated vs. Complicated Urinary 1. renal function is normal, urine results may confirm a UTI,
Tract Infections (UTI) but the patient denies symptoms, no antibiotic is
1. A UTI may be classified as prescribed
complicated or uncomplicated in terms of 2.renal function and an abnormality in the renal tract
its severity. An uncomplicated UTI
indicates that
2.In a complicated UTI, there is decreased
Un-Complicated UTI 1. the normal urinary tract
1. Occurs in the normal urinary tract 2.a short course of antibiotic therapy
2.Responds well to 3.non-pregnant women without any urologic abnormalities
3.Ie: Simple cystitis in 4. the bladder
Complicated UTI 5. structural or functional urinary tract abnormalities
4.A UTI that extends beyond or untreated UTI
5.Caused by 6.pregnant mothers & older adults affected
6.Infants and 7. indwelling catheters, renal calculi, diabetes, pregnancy
7. Associated with:
1. The most common organisms that 1. Escherichia coli (80% of cases),
cause a UTI is Staphylococcus saprophyticus, Proteus
2. A urinalysis is used to diagnose a Mirabilis, and Klebsiella.
UTI. If nitrites are present, this 2.the causative organism is gram negative
indicates 3.100,000 colony forming units/ml. remember a UTI occurs
3.A urine culture may also be performed to when bacteria colonize, cling to the bladder well, form
determine infection. A positive culture biofilms and overwhelm the immune system
indicates that there are greater than
Using the Urinalysis to Diagnose a Urinary 1. the case of Enterococcus bacteria
Tract Infection 2.the highest positive predictive value.
1. some bacteria are unable to Complicated
produce nitrites. this would be Protein + or –
2. The presence of nitrites is Leukocyte Esterase +
the most specific finding and has Nitrites + or –
Differentiate between the UA of a RBCs +
complicated and uncomplicated UTI WBCs + > 100,000/hpf
Protein Casts +
Leukocyte Esterase Uncomplicated
Nitrites Protein + or –
RBCs Leukocyte Esterase +
WBCs Nitrites + or –
Casts RBCs + or –
WBCs + > 5000/hpf
Casts None
Remember a for a dx of UTI the pt needs to be presenting
with symptoms
Casts: are long cylindrical structures 1. acute tubular necrosis
formed in the renal tubules due to the 2.acute and chronic renal failure.
precipitation of Tamm-Horsfall 3.nephrotic syndrome
mucoprotein 4. glomerulonephritis
1. Muddy brown casts suggest 5. interstitial inflammation
2.Waxy casts are suggestive of
3.Fatty casts are suggestive of
4. RBC casts suggest
5.WBC casts suggest
