NR 507 PATHO FINAL TEST QUESTIONS
AND ANSWERS
UTI risk factors
1. For women, pregnancy is a risk factor. why?
2. The female ureter is shorter and
3. Post-menopausal women are also at risk because
4. Sexual intercourse is a risk factor especially if women use
5. Indwelling urinary catheterization is also a major cause of a UTI - Answer-1. During
pregnancy, progesterone relaxes smooth muscle that causes stasis of urine, allowing
the bacteria to colonize
2. allows for the entrance of bacteria into the urethra.
3. lack of estrogen results in vaginal and urethral dryness promoting an environment for
bacteria growth.
4. spermicides
5. Fibrinogen accumulates on the catheter which provides an ideal environment for the
attachment of uropathogens that then form biofilms. This results in epithelial damage
Lower vs. Upper Tract Disorders
1. Lower UTI's include what parts of the urinary tract
2. In a lower urinary tract disorder, the individual experiences (blank) Other common
symptoms include
3. initially, a urine dipstick can be performed to identify hematuria, proteinuria, and the
presence of nitrites. 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 - Answer-1. urethra
(urethritis) or bladder (cystitis). In males, the cystitis may be associated with prostatitis.
2. urgency associated with burning on urination. frequency, dysuria, and suprapubic
pain. The urine may also appear cloudy and have an odor.
3. is highly specific for bacterial infection
4. culture and sensitivity (C&S) test and microscopy
5. a white blood cell (WBC) count of greater than 5000 high power field (hpf) and
hematuria
1. An infection of the lower urinary tract can progress to an upper urinary tract infection
if the bacteria ascends from the bladder to the kidney. The condition is
2. The signs and symptoms of pyelonephritis include
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 - Answer-1.
pyelonephritis.
2. all the symptoms associated with cystitis plus fever, flank pain, costovertebral angle
(CVA) tenderness, nausea, and vomiting. Malaise is also a common complaint
,3. vomiting, flank pain and fever
4. there can also be signs of shock
5. WBC casts
Uncomplicated vs. Complicated Urinary Tract Infections (UTI)
1. A UTI may be classified as complicated or uncomplicated in terms of its severity. An
uncomplicated UTI indicates that
2. In a complicated UTI, there is decreased - Answer-1. renal function is normal, urine
results may confirm a UTI, but the patient denies symptoms, no antibiotic is prescribed
2. renal function and an abnormality in the renal tract
Un-Complicated UTI
1. Occurs in the normal urinary tract
2. Responds well to
3. Ie: Simple cystitis in
Complicated UTI
4. A UTI that extends beyond
5. Caused by
6. Infants and
7. Associated with: - Answer-1. the normal urinary tract
2. a short course of antibiotic therapy
3. non-pregnant women without any urologic abnormalities
4. the bladder
5. structural or functional urinary tract abnormalities or untreated UTI
6. pregnant mothers & older adults affected
7. indwelling catheters, renal calculi, diabetes, pregnancy
1. The most common organisms that cause a UTI is
2. A urinalysis is used to diagnose a UTI. If nitrites are present, this indicates
3. A urine culture may also be performed to determine infection. A positive culture
indicates that there are greater than - Answer-1. Escherichia coli (80% of cases),
Staphylococcus saprophyticus, Proteus Mirabilis, and Klebsiella.
2. the causative organism is gram negative
3. 100,000 colony forming units/ml. remember a UTI occurs when bacteria colonize,
cling to the bladder well, form biofilms and overwhelm the immune system
Using the Urinalysis to Diagnose a Urinary Tract Infection
1. some bacteria are unable to produce nitrites. this would be
2. The presence of nitrites is the most specific finding and has
Differentiate between the UA of a complicated and uncomplicated UTI
Protein
Leukocyte Esterase
Nitrites
RBCs
WBCs
Casts - Answer-1. the case of Enterococcus bacteria
,2. the highest positive predictive value.
Complicated
Protein + or -
Leukocyte Esterase +
Nitrites + or -
RBCs +
WBCs + > 100,000/hpf
Casts +
Uncomplicated
Protein + or -
Leukocyte Esterase +
Nitrites + or -
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 formed in the renal tubules due to the precipitation
of Tamm-Horsfall mucoprotein
1. Muddy brown casts suggest
2. Waxy casts are suggestive of
3. Fatty casts are suggestive of
4. RBC casts suggest
5. WBC casts suggest - Answer-1. acute tubular necrosis
2. acute and chronic renal failure.
3. nephrotic syndrome
4. glomerulonephritis
5. interstitial inflammation
RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal
morphology of the RBC strongly suggests - Answer-glomerular disease.
UTI Prevention, list patient education
1. most important
2. can help to acidify the urine
3. Urinate before and after
4. Encourage the female to avoid
5. Avoid the use of - Answer-1. Drink more water.
2. cranberry juice and vitamin C
3. sexual intercourse to remove bacteria from the urethral area.
4. holding urine for extended periods of time
5. hygiene sprays and spermicides because they alter the normal microbial flora
Post UTI quiz - Answer-...
, A 25 year- old female presents to the primary care office with urinary burning and
frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological
history is negative and reports no vaginal discharge. The only new information reported
is that she recently had sexual intercourse with a new male partner.
The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs,
nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA
results, the patient can be diagnosed with:
a. Upper UTI
b. Complicated UTI
c. Pyelonephritis
d. Cystitis - Answer-d. Cystitis
J.S. is an 80 -year-old patient who resides in a local nursing home. He recently became
confused and then fell while ambulating. after the catheter was placed, the patient
spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense,
foul odor was noted in the urine. On examination of the flank area, the patient yelled out
when touched. A urine culture was obtained and came back positive for nitrites and
RBCs. Urine microscopy revealed >100,000 WBC/hpf and casts.Based on the
information provided in the case, the patient can most likely be diagnosed with:
a. Pyelonephritis
b. Urinary obstruction
c. Glomerulonephritis
d. Simple UTI - Answer-a. Pyelonephritis
Identify the major risk factor J.S. has that is associated with pyelonephritis: Select all
that apply
Dehydration
Indwelling Foley catheter
Fever
Flank pain - Answer-Indwelling Foley catheter
A 21-year-old patient reports to the primary care clinic complaining of urinary urgency,
frequency and burning. She also reports a small amount of vaginal discharge that
contains an odor. It is likely that the NP will perform a vaginal exam at this visit.
True
False - Answer-True (pt could also have an STI)
The urinalysis of a patient with a complicated UTI will show WBCs and casts
True
False - Answer-True
Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria
are gram negative because of the presence of:
RBCs.
Casts.
WBCs.
AND ANSWERS
UTI risk factors
1. For women, pregnancy is a risk factor. why?
2. The female ureter is shorter and
3. Post-menopausal women are also at risk because
4. Sexual intercourse is a risk factor especially if women use
5. Indwelling urinary catheterization is also a major cause of a UTI - Answer-1. During
pregnancy, progesterone relaxes smooth muscle that causes stasis of urine, allowing
the bacteria to colonize
2. allows for the entrance of bacteria into the urethra.
3. lack of estrogen results in vaginal and urethral dryness promoting an environment for
bacteria growth.
4. spermicides
5. Fibrinogen accumulates on the catheter which provides an ideal environment for the
attachment of uropathogens that then form biofilms. This results in epithelial damage
Lower vs. Upper Tract Disorders
1. Lower UTI's include what parts of the urinary tract
2. In a lower urinary tract disorder, the individual experiences (blank) Other common
symptoms include
3. initially, a urine dipstick can be performed to identify hematuria, proteinuria, and the
presence of nitrites. 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 - Answer-1. urethra
(urethritis) or bladder (cystitis). In males, the cystitis may be associated with prostatitis.
2. urgency associated with burning on urination. frequency, dysuria, and suprapubic
pain. The urine may also appear cloudy and have an odor.
3. is highly specific for bacterial infection
4. culture and sensitivity (C&S) test and microscopy
5. a white blood cell (WBC) count of greater than 5000 high power field (hpf) and
hematuria
1. An infection of the lower urinary tract can progress to an upper urinary tract infection
if the bacteria ascends from the bladder to the kidney. The condition is
2. The signs and symptoms of pyelonephritis include
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 - Answer-1.
pyelonephritis.
2. all the symptoms associated with cystitis plus fever, flank pain, costovertebral angle
(CVA) tenderness, nausea, and vomiting. Malaise is also a common complaint
,3. vomiting, flank pain and fever
4. there can also be signs of shock
5. WBC casts
Uncomplicated vs. Complicated Urinary Tract Infections (UTI)
1. A UTI may be classified as complicated or uncomplicated in terms of its severity. An
uncomplicated UTI indicates that
2. In a complicated UTI, there is decreased - Answer-1. renal function is normal, urine
results may confirm a UTI, but the patient denies symptoms, no antibiotic is prescribed
2. renal function and an abnormality in the renal tract
Un-Complicated UTI
1. Occurs in the normal urinary tract
2. Responds well to
3. Ie: Simple cystitis in
Complicated UTI
4. A UTI that extends beyond
5. Caused by
6. Infants and
7. Associated with: - Answer-1. the normal urinary tract
2. a short course of antibiotic therapy
3. non-pregnant women without any urologic abnormalities
4. the bladder
5. structural or functional urinary tract abnormalities or untreated UTI
6. pregnant mothers & older adults affected
7. indwelling catheters, renal calculi, diabetes, pregnancy
1. The most common organisms that cause a UTI is
2. A urinalysis is used to diagnose a UTI. If nitrites are present, this indicates
3. A urine culture may also be performed to determine infection. A positive culture
indicates that there are greater than - Answer-1. Escherichia coli (80% of cases),
Staphylococcus saprophyticus, Proteus Mirabilis, and Klebsiella.
2. the causative organism is gram negative
3. 100,000 colony forming units/ml. remember a UTI occurs when bacteria colonize,
cling to the bladder well, form biofilms and overwhelm the immune system
Using the Urinalysis to Diagnose a Urinary Tract Infection
1. some bacteria are unable to produce nitrites. this would be
2. The presence of nitrites is the most specific finding and has
Differentiate between the UA of a complicated and uncomplicated UTI
Protein
Leukocyte Esterase
Nitrites
RBCs
WBCs
Casts - Answer-1. the case of Enterococcus bacteria
,2. the highest positive predictive value.
Complicated
Protein + or -
Leukocyte Esterase +
Nitrites + or -
RBCs +
WBCs + > 100,000/hpf
Casts +
Uncomplicated
Protein + or -
Leukocyte Esterase +
Nitrites + or -
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 formed in the renal tubules due to the precipitation
of Tamm-Horsfall mucoprotein
1. Muddy brown casts suggest
2. Waxy casts are suggestive of
3. Fatty casts are suggestive of
4. RBC casts suggest
5. WBC casts suggest - Answer-1. acute tubular necrosis
2. acute and chronic renal failure.
3. nephrotic syndrome
4. glomerulonephritis
5. interstitial inflammation
RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal
morphology of the RBC strongly suggests - Answer-glomerular disease.
UTI Prevention, list patient education
1. most important
2. can help to acidify the urine
3. Urinate before and after
4. Encourage the female to avoid
5. Avoid the use of - Answer-1. Drink more water.
2. cranberry juice and vitamin C
3. sexual intercourse to remove bacteria from the urethral area.
4. holding urine for extended periods of time
5. hygiene sprays and spermicides because they alter the normal microbial flora
Post UTI quiz - Answer-...
, A 25 year- old female presents to the primary care office with urinary burning and
frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological
history is negative and reports no vaginal discharge. The only new information reported
is that she recently had sexual intercourse with a new male partner.
The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs,
nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA
results, the patient can be diagnosed with:
a. Upper UTI
b. Complicated UTI
c. Pyelonephritis
d. Cystitis - Answer-d. Cystitis
J.S. is an 80 -year-old patient who resides in a local nursing home. He recently became
confused and then fell while ambulating. after the catheter was placed, the patient
spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense,
foul odor was noted in the urine. On examination of the flank area, the patient yelled out
when touched. A urine culture was obtained and came back positive for nitrites and
RBCs. Urine microscopy revealed >100,000 WBC/hpf and casts.Based on the
information provided in the case, the patient can most likely be diagnosed with:
a. Pyelonephritis
b. Urinary obstruction
c. Glomerulonephritis
d. Simple UTI - Answer-a. Pyelonephritis
Identify the major risk factor J.S. has that is associated with pyelonephritis: Select all
that apply
Dehydration
Indwelling Foley catheter
Fever
Flank pain - Answer-Indwelling Foley catheter
A 21-year-old patient reports to the primary care clinic complaining of urinary urgency,
frequency and burning. She also reports a small amount of vaginal discharge that
contains an odor. It is likely that the NP will perform a vaginal exam at this visit.
True
False - Answer-True (pt could also have an STI)
The urinalysis of a patient with a complicated UTI will show WBCs and casts
True
False - Answer-True
Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria
are gram negative because of the presence of:
RBCs.
Casts.
WBCs.
