NRNP 6550 Final Exam Questions and Answers Latest Update 2024 (100% Graded)

NRNP 6550 Final Exam Questions and Answers Latest Update 2024 (100% Graded) Urine culture with UTI Correct answer- 100.000 colonies in asymptomatic: bacteruria 10 - 10.000 colonies in symptomatic patients but also pyuria pyuria: more than 10 leukocytes elevated erythrocytes with pyelonephritis WBC in urine false positive with tumor, urethritis and poor collection technique Repeat in pregnant women Lower urinary tract UTI and upper urinary tract UTI Correct answer- bladder and urethra: cystitis/ urethritis/ prostatitis kidney and ureters: pyelonephritis/ renal abcess Uncomplicated and complicated uti Correct answer- Uncomplicated: in normal working urinary tract Complicated: defects in urinary tract or with other health problems Common pathogens for UTI Correct answer- E.coli (elderly women) Staphylococcus proteus mirabilis (elderly men) Klebsiella enterecoccus pseudomonas Providencia (institutionalized) Fungus: candida Risk factors for UTI Correct answer- Female critically ill elderly catheter (caused by biofilm) DM calculi, tumor, stricture neurogenic bladder Women: sexual intercourse or new sex partner pregnancy previous UTI Men: prostate enlargement prostatitis lack of circumcision gay HIV Findings UTI Correct answer- Lower: Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills uncommon No flank pain Upper: flank pain fever and chills hematuria n/v ams (in elderly) malaise tachycardia/ tachypnea Testing and results for UTI Correct answer- Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis. UA: pos for nitrite or leukocyte or blood CBC: leukocyte with left shift in pyelonephritis For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with: xr voiding CT abdomen US pelvis MRI pelvis Management acute cystitis Correct answer- First line: - Single dose Fosfomycin (monurol) - 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead) or sulfa - 5 days: nitrofurantoin, caution in elderly Second line: - qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!) - B-lactams: amoxi-clav, cefdinir for 3 - 7 days Management uncomplicated upper UTI Correct answer- Outpt: quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days Sulfa: trimethoprim/ sulfa (bactrim) for 14 days Inpt: Ceftriaxone or cefotaxime Ampicillin CAUTI: bacterial: treat with AB for 7 days Candiduria: fluconazole for 14 days Discomfort: Pyridium Management acute complicated bacterial pyelonephritis Correct answer- - Admit - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD - Ampicillin - Cefazolin - Cefotaxime and Ceftriaxon based on obesity and pulm disease Urine analysis: glucose and ketones Correct answer- Serum glucose at least 180mg/dl for glucose to appear in urine Glucose in ua caused by: - Fancone Syndrome (bad wall: caused by ahminoglycosides for example) - DM - Cushing's - Vit C can give false negative Ketones in urine: - Alcohol - Diabetic - Starvation Acute Kidney Injury Correct answer- -Acute renal function loss with inability to excrete metabolic waste products (urea nitrogen and creatinine) to inability to maintain fluid and electrolyte balance. - Resolves within 3mo - classified with RIFLE or etiology RIFLE Correct answer- Risk: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less than 0.5ml/kg/hr for 6hr Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less than 0.5ml/kg/hr for 12hr Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO less than 0.3ml/kg/hr for 12hr or anuria for 12hr Loss: Complete loss of renal function for more than 4 weeks End-stage Kidney Disease: RRT need for more than 3mo Prerenal renal failure Correct answer- Most often the cause of RF - Decreased blood supply; intravascular volume depletion, vasodilatory states - Increased tubular sodium and water reabsorption, causing: oliguria, decreased urine sodium, high urine osmolality, increased urine specific gravity caused by: 1. Low CO 2. Hypovolemia 3. RAS (renal artery stenosis) 4. aminoglycosides, NSAIDS Result: - low urine volume - increased urine creatinine with normal serum creatinine - minimal proteinuria - serum K moderately increased - serum phos moderately increased - serum calcium normal - normal renal size on US 4. Low Na+ 5. Low H2O 6. High osmolality (500 and up) 7. High uric acid 8. Specific gravity: greater than 1,010 9. Urinary sodium: less than 20 10. Sediment*: 0 (hyaline casts) 11. BUN/ creat ratio: greater than 10/1 Intrarenal Correct answer- Cause: - Ischemia or nephrotixic injury (rhabdo, multiple myeloma, aminoglycosides, chemo, contrast) - Necrosis (acute tubular necrosis ATN) (prolonged hypotension, low CO, liver disease) - Acute tubulointerstitial nephritis from bacterial pyelonephritis, drug-induced, immunologic disorders - oliguric/ anuric - decreased urine creatinine - no proteinuria - serum creatinine increased - serum K increased - serum phos increased - serum Calcium decreased Low Na+ High H2O Low osmolality (350 and less) Specific gravity: 1,010 Urinary sodium: greater than 20 Sediment: + BUN/ creat ratio: less than 20/1 FEna: greater than 2% Treat: stop offending drug. Contrast: fluid administration, pre- and post. Hold metformin before contrast, for 48hrs. Postrenal Correct answer- Cause: Urinary flow obstruction: Enlarged prostate Cervical cancer Tumors Kidney stones Neurogenic bladder, diabetic neuropathy, spinal cord disease - urine creatinine decreased - no proteinuria - no sediment or hematuria with stones - BUN increased - serum creatinine increased - serum phos increased - serum calcium decreased Anuria/ polyuria Urine osmolality less than 350 Fixed urine specific gravity (1.0008- 1.012) Urine Na greater than 40 BUN to creatinine ratio: greater than 20:1 Treat with catheter drainage, urethral stents, percutaneous nephrostomy treatment of ARF/AKI Correct answer- -· Therapy for ARF: o Treat underlying cause o Correct fluid, electrolyte, uremic abnormalities o Prevent complications o Lasix can be given for volume overload (due to oliguria) o Patient can become nutritionally deficient as ARF is a catabolic state. Total caloric intake: 30 - 45 kcal/kg/day. Protein restricted when not on dialysis: 0.6g/ kg/day. If on dialysis protein should be 1-1.5g/kg/day. Diet should be low protein/ Na/ K o Dialysis, often needed. Especially when BUN greater than 100 and serum creatinine greater than 5 - 10, acidosis/ alkalosis, hyperkalemia o Metabolic acidosis: treat with IV (or oral) bicarb when serum HCO3 is less than 15, or PH less than 7.2 o Renal transplant Treat renal failure complications: which and how Correct answer- Hyperkalemia: - Kayelxalate 15-30 g with 100 ml sorbitol: enema - IV calcium: cardioprotective - Insulin (10units) with 25 g glucose - IV sodium Bicarb (150 mEq in 1 lt) - dialysis in significantly elevated K (greater than 7) Hyperphosphatemia: - Keep below 4.6 - Restrict phos (cola, eggs, dairy, meat) - Give calcium carbonate (650mg TID) - Renvela (Sevelamir) - Calcium acetate - Dialysis Hypocalcemia (ion Ca less than 1.12): - Calcium carbonate supplements - maintain phos at 6 Hypermagnesemia Avoid mag. laxatives Fluid overload: - Decrease Na and fluid intake and give lasix HTN: Goal: 140/80 unless proteinuria than 125/75 ACE-inhib, calcium blockers if proteinuria present, hydralazine, B-blocker Protein catabolism: - Limit protein intake: less than 8gr/, avoid stress and not too much physical activity Acidosis Give sodium citrate when HCO3 below 20 Anemia - give iron - give erythropoietin injection RRT option in AKI and CKD Correct answer- - Hemodialysis (intermittent (MAP of at least 60mmHg), continuously venous or arterial) - Peritoneal dialysis - for long term use. Does not achieve adequate creatinine clearance (may be switched to hemodialysis in acute care situations) and high risk for infection chronic kidney disease Correct answer- · Chronic kidney disease: GFR 60ml/ min or less for longer than 3mo. o HTN common o US with show bilat small kidneys