NURS 536 Final Exam with correct |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
Risk factors for UTI - correct answer✔✔•Sexually active
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Postmenopausal
•Woman who uses birth control methods such as diaphragms or spermicide
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Those individuals who have trouble emptying your bladder completely, such as spinal cord
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
injury or those with nerve damage around the bladder
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Urinary tract obstruction such as urinary stricture, enlarged prostate or renal calculi
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Abnormality of the urinary tract, such as vesicoureteral reflux (VUR) |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•DM, immunocompromised |||\\\
•Recent instrumentation |||\\\
•Prior UTI |||\\\
Bacterial causes of UTI - correct answer✔✔E. coli |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Klebsiella pneumoniae |||\\\
P. aeruginosa
|||\\\
UTI Symptoms - correct answer✔✔-pain/burning when urinating
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-frequent urination |||\\\
-kidney pain |||\\\
UTI symptoms in the elderly - correct answer✔✔Falls, changes in mental status
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Asymptomatic bacteriuria - correct answer✔✔•Cloudy or malodorous urine may be associated |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
with bacteriuria
|||\\\ |||\\\
•Color and odor of urine can be influenced by ingestion of certain foods, dehydration and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
other noninfectious factors
|||\\\ |||\\\
UTI Diagnosis - correct answer✔✔UA:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Abnormal result: Leukocyte esterase, nitrites, white blood cells
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Hematuria is not a predictor for complicated infection and does not alter the approach to
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
therapy
•White blood cell casts in the urine, although rare, are indicative of upper tract infection rather
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
than simple cystitis
|||\\\ |||\\\ |||\\\
Differential Diagnosis for UTI - correct answer✔✔•Vaginitis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Urethritis
•Interstitial cystitis |||\\\
•PID
•Epididymitis (men) |||\\\
•Prostatitis (men) |||\\\
Complicated UTI - correct answer✔✔•Fever (>99.9°F/37.7°C), signs of sepsis |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Chills, rigors, marked fatigue or malaise
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Flank pain or costovertebral angle tenderness
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,UTI Treatments - Low Risk - correct answer✔✔Low risk patients:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Macrobid, Bactrim, fosfomycin, pivmecillinam |||\\\ |||\\\ |||\\\
•Alternative: fluoroquinolone, Augmentin, cefpodoxime, cefdinir, cefadroxil |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
UTI Treatments - High risk - correct answer✔✔High risk patients:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
|||\\\ *obtain culture |||\\\
Outpatient management of complicated infection |||\\\ |||\\\ |||\\\ |||\\\
+/-Following the dose of the parenteral agent, options include the following: |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cipro 500mg BID or 1000mg ER once daily or Levaquin 750mg once daily 7 to 10 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Trimethoprim-sulfamethoxazole - one double-strength (160 mg/800 mg) tablet orally twice |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
daily for 7 to 10 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Amoxicillin-clavulanate - 875 mg orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefpodoxime - 200 mg orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefdinir - 300 mg orally twice daily for 10 to 14 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefadroxil - 1 g orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - correct answer✔✔inflammation of the kidney and renal pelvis |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
, Pyleonephritis - Who? - correct answer✔✔•In females: An elevated incidence in girls aged 0-4
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
years, a peak in women 15-35 years of age, and a gradual increase after age 50 years to
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
another peak at 80 years of age.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis Symptoms - correct answer✔✔•Fever - This is not always present, 103°F
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
(39.4°C)
•Costovertebral angle pain |||\\\ |||\\\ |||\\\
•Nausea and/or vomiting - Vary in frequency and intensity, from absent to severe; anorexia is
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
common in patients with acute pyelonephritis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - Clinical findings - correct answer✔✔Urinalysis can include the following:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Dipstick leukocyte esterase test (pyuria)
|||\\\ |||\\\ |||\\\ |||\\\
•Nitrite production
|||\\\
•Examination for hematuria (gross and microscopic) and proteinuria |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - Diagnosis - correct answer✔✔UA: Leuks, nitrites, increased pH, hematuria
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Microscopic: >5 WBC and bacteriuria |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Urine Cx: 100,000 CFU/m
|||\\\ |||\\\ |||\\\
Pyelonephritis Treatments - correct answer✔✔Inpatient care includes the following: |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Monitoring of urine and blood culture results |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Monitor renal function |||\\\ |||\\\
•Monitoring of comorbid conditions for deterioration |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Maintenance of hydration status with IV fluids until hydration can be maintained with oral
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
intake
answers
Risk factors for UTI - correct answer✔✔•Sexually active
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Postmenopausal
•Woman who uses birth control methods such as diaphragms or spermicide
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Those individuals who have trouble emptying your bladder completely, such as spinal cord
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
injury or those with nerve damage around the bladder
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Urinary tract obstruction such as urinary stricture, enlarged prostate or renal calculi
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Abnormality of the urinary tract, such as vesicoureteral reflux (VUR) |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•DM, immunocompromised |||\\\
•Recent instrumentation |||\\\
•Prior UTI |||\\\
Bacterial causes of UTI - correct answer✔✔E. coli |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Klebsiella pneumoniae |||\\\
P. aeruginosa
|||\\\
UTI Symptoms - correct answer✔✔-pain/burning when urinating
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-frequent urination |||\\\
-kidney pain |||\\\
UTI symptoms in the elderly - correct answer✔✔Falls, changes in mental status
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Asymptomatic bacteriuria - correct answer✔✔•Cloudy or malodorous urine may be associated |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
with bacteriuria
|||\\\ |||\\\
•Color and odor of urine can be influenced by ingestion of certain foods, dehydration and
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
other noninfectious factors
|||\\\ |||\\\
UTI Diagnosis - correct answer✔✔UA:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Abnormal result: Leukocyte esterase, nitrites, white blood cells
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Hematuria is not a predictor for complicated infection and does not alter the approach to
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
therapy
•White blood cell casts in the urine, although rare, are indicative of upper tract infection rather
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
than simple cystitis
|||\\\ |||\\\ |||\\\
Differential Diagnosis for UTI - correct answer✔✔•Vaginitis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Urethritis
•Interstitial cystitis |||\\\
•PID
•Epididymitis (men) |||\\\
•Prostatitis (men) |||\\\
Complicated UTI - correct answer✔✔•Fever (>99.9°F/37.7°C), signs of sepsis |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Chills, rigors, marked fatigue or malaise
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Flank pain or costovertebral angle tenderness
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,UTI Treatments - Low Risk - correct answer✔✔Low risk patients:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Macrobid, Bactrim, fosfomycin, pivmecillinam |||\\\ |||\\\ |||\\\
•Alternative: fluoroquinolone, Augmentin, cefpodoxime, cefdinir, cefadroxil |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
UTI Treatments - High risk - correct answer✔✔High risk patients:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
|||\\\ *obtain culture |||\\\
Outpatient management of complicated infection |||\\\ |||\\\ |||\\\ |||\\\
+/-Following the dose of the parenteral agent, options include the following: |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cipro 500mg BID or 1000mg ER once daily or Levaquin 750mg once daily 7 to 10 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Trimethoprim-sulfamethoxazole - one double-strength (160 mg/800 mg) tablet orally twice |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
daily for 7 to 10 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Amoxicillin-clavulanate - 875 mg orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefpodoxime - 200 mg orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefdinir - 300 mg orally twice daily for 10 to 14 days
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Cefadroxil - 1 g orally twice daily for 10 to 14 days |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - correct answer✔✔inflammation of the kidney and renal pelvis |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
, Pyleonephritis - Who? - correct answer✔✔•In females: An elevated incidence in girls aged 0-4
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
years, a peak in women 15-35 years of age, and a gradual increase after age 50 years to
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
another peak at 80 years of age.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis Symptoms - correct answer✔✔•Fever - This is not always present, 103°F
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
(39.4°C)
•Costovertebral angle pain |||\\\ |||\\\ |||\\\
•Nausea and/or vomiting - Vary in frequency and intensity, from absent to severe; anorexia is
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
common in patients with acute pyelonephritis
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - Clinical findings - correct answer✔✔Urinalysis can include the following:
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Dipstick leukocyte esterase test (pyuria)
|||\\\ |||\\\ |||\\\ |||\\\
•Nitrite production
|||\\\
•Examination for hematuria (gross and microscopic) and proteinuria |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Pyelonephritis - Diagnosis - correct answer✔✔UA: Leuks, nitrites, increased pH, hematuria
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Microscopic: >5 WBC and bacteriuria |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Urine Cx: 100,000 CFU/m
|||\\\ |||\\\ |||\\\
Pyelonephritis Treatments - correct answer✔✔Inpatient care includes the following: |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Monitoring of urine and blood culture results |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Monitor renal function |||\\\ |||\\\
•Monitoring of comorbid conditions for deterioration |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
•Maintenance of hydration status with IV fluids until hydration can be maintained with oral
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
intake
