NR 507 TEST GUIDE QUESTIONS AND
ANSWERS
Cystitis - Answer-Denotes a bladder infection
Pyelonephritis - Answer-Inflammation of kidneys
Diagnostic UTI - Answer-Urine dipstick
Urinalysis - used to diagnose a UTI
Urine Culture & Sensitivity
Urine Dipstick - Answer--Urine Dipstick can be observed for the presence of leukocyte
esterase and nitrites.
-A urine dipstick can be performed to identify hematuria, proteinuria, and the presence
of nitrites. The presence of nitrites i.s highly specific for bacterial infection
-Note that an individual can have a negative urine dipstick but still present with signs
and symptoms of a UTI. If this is the case, then the NP can send the urine for a culture
and sensitivity (C&S) test and microscopy.
Blood Culture - Answer-If sepsis is suspected, a blood culture may be drawn to identify
the causative organism or rule it out.
Urine Culture & Sensitivity - Answer-Patient with cystitis will have a white blood cell
(WBC) count of greater than 5000 high power field (hpf) and hematuria.
Patient with pyelonephritis, the urine will present with WBC casts. The presence of
casts in the urine indicates that the protein in the lumen of the kidney tubules has
solidified, especially in the nephron. This indicates kidney disease rather than a lower
UTI.
Urine can also be examined microscopically to determine the presence of a lower or
upper UTI. The following may be seen in urine examined under microscopy:
- RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal
morphology of the RBC strongly suggests glomerular disease. RBCs are often present
with a UTI (hematuria).
-WBCs: greater than 5 WBCs/hpf is considered abnormal. These will be present in a
UTI.
-Bacteria: will be present
-Crystals: these are microscopic solids composed of a small number of different ions
and molecules. These are common in the urine and if they remain small, are not
pathologic.
, -Casts: are long cylindrical structures formed in the renal tubules due to the precipitation
of Tamm-Horsfall mucoprotein. It is the most abundant protein excreted by the urine.
Casts form in concentrated and/or acidic urine. The most common casts are hyaline
casts that only consist of Tamm-Horsfall protein without other constituents. They are
non-specific and may be seen in dehydration. Muddy brown casts suggest acute tubular
necrosis. Waxy casts are suggestive of acute and chronic renal failure. Fatty casts are
suggestive of nephrotic syndrome; RBC casts suggest glomerulonephritis and WBC
casts suggest interstitial inflammation.
Complicate vs. Uncomplicated UTI - Answer-UTI may be classified as complicated or
uncomplicated in terms of its severity:
Complicated UTI, there is decreased renal function and an abnormal urinary tract
-The more intervention required, the more complicated the infection
-Exception would be during pregnancy due to the ureteral dilation that occurs that
increases the risk for pyelonephritis. Even though she may be asymptomatic, treatment
would be initiated to prevent damage to the fetus in utero.
-Complicated UTI (pyelonephritis) will require intravenous (IV antibiotics) until the
patient is afebrile, followed by a course of oral antibiotics. Overall, the course of
antibiotics for a complicated infection is longer than in an individual that has an
uncomplicated infection.
Uncomplicated UTI indicates that the urinary tract and renal function is normal
-An uncomplicated, symptomatic UTI (cystitis) will typically require a 3-7 days course of
appropriate antibiotic therapy.
Complicate vs. Uncomplicated UTI - Answer-Complicated
-A UTI that extends beyond the bladder
-Caused by structural or functional urinary tract abnormalities or untreated UTI
-Infants and older adults affected
-Associated with:
indwelling catheters
renal calculi
Diabetes
Pregnancy
Uncomplicated
-Occurs in the normal urinary tract
-Responds well to a short course of antibiotic therapy
-Simple cystitis in non-pregnant women without any urologic abnormalities
Urologist - Answer--Referral to a urologist is necessary if the individual does not
respond to antibiotic treatment or if there are recurrent UTIs, specifically 3 or more in
one year
ANSWERS
Cystitis - Answer-Denotes a bladder infection
Pyelonephritis - Answer-Inflammation of kidneys
Diagnostic UTI - Answer-Urine dipstick
Urinalysis - used to diagnose a UTI
Urine Culture & Sensitivity
Urine Dipstick - Answer--Urine Dipstick can be observed for the presence of leukocyte
esterase and nitrites.
-A urine dipstick can be performed to identify hematuria, proteinuria, and the presence
of nitrites. The presence of nitrites i.s highly specific for bacterial infection
-Note that an individual can have a negative urine dipstick but still present with signs
and symptoms of a UTI. If this is the case, then the NP can send the urine for a culture
and sensitivity (C&S) test and microscopy.
Blood Culture - Answer-If sepsis is suspected, a blood culture may be drawn to identify
the causative organism or rule it out.
Urine Culture & Sensitivity - Answer-Patient with cystitis will have a white blood cell
(WBC) count of greater than 5000 high power field (hpf) and hematuria.
Patient with pyelonephritis, the urine will present with WBC casts. The presence of
casts in the urine indicates that the protein in the lumen of the kidney tubules has
solidified, especially in the nephron. This indicates kidney disease rather than a lower
UTI.
Urine can also be examined microscopically to determine the presence of a lower or
upper UTI. The following may be seen in urine examined under microscopy:
- RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal
morphology of the RBC strongly suggests glomerular disease. RBCs are often present
with a UTI (hematuria).
-WBCs: greater than 5 WBCs/hpf is considered abnormal. These will be present in a
UTI.
-Bacteria: will be present
-Crystals: these are microscopic solids composed of a small number of different ions
and molecules. These are common in the urine and if they remain small, are not
pathologic.
, -Casts: are long cylindrical structures formed in the renal tubules due to the precipitation
of Tamm-Horsfall mucoprotein. It is the most abundant protein excreted by the urine.
Casts form in concentrated and/or acidic urine. The most common casts are hyaline
casts that only consist of Tamm-Horsfall protein without other constituents. They are
non-specific and may be seen in dehydration. Muddy brown casts suggest acute tubular
necrosis. Waxy casts are suggestive of acute and chronic renal failure. Fatty casts are
suggestive of nephrotic syndrome; RBC casts suggest glomerulonephritis and WBC
casts suggest interstitial inflammation.
Complicate vs. Uncomplicated UTI - Answer-UTI may be classified as complicated or
uncomplicated in terms of its severity:
Complicated UTI, there is decreased renal function and an abnormal urinary tract
-The more intervention required, the more complicated the infection
-Exception would be during pregnancy due to the ureteral dilation that occurs that
increases the risk for pyelonephritis. Even though she may be asymptomatic, treatment
would be initiated to prevent damage to the fetus in utero.
-Complicated UTI (pyelonephritis) will require intravenous (IV antibiotics) until the
patient is afebrile, followed by a course of oral antibiotics. Overall, the course of
antibiotics for a complicated infection is longer than in an individual that has an
uncomplicated infection.
Uncomplicated UTI indicates that the urinary tract and renal function is normal
-An uncomplicated, symptomatic UTI (cystitis) will typically require a 3-7 days course of
appropriate antibiotic therapy.
Complicate vs. Uncomplicated UTI - Answer-Complicated
-A UTI that extends beyond the bladder
-Caused by structural or functional urinary tract abnormalities or untreated UTI
-Infants and older adults affected
-Associated with:
indwelling catheters
renal calculi
Diabetes
Pregnancy
Uncomplicated
-Occurs in the normal urinary tract
-Responds well to a short course of antibiotic therapy
-Simple cystitis in non-pregnant women without any urologic abnormalities
Urologist - Answer--Referral to a urologist is necessary if the individual does not
respond to antibiotic treatment or if there are recurrent UTIs, specifically 3 or more in
one year
