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Nurs 640 Exam 4 Latest Update ) Exam | Questions and
Verified Answers | 100% Correct | Grade A +
Hematuria - ANSWER work up: infection/anticoagulation
Urinary stone disease - ANSWER most common Ca
s/s: hematuria/ severe colic, acute flank pain, N&V
Testing: Ultrasound or spiral non contract CT.
BPH (benign prostatic hyperplasia) - ANSWER noncancerous
enlargement of the prostate
s/s hesitancy
DRE (digital rectal exam): enlarged prostate.
Med: alpha blockers
procedures: TURP
Acute Urinary retention - ANSWER cause: BPH or medication
S/S: lower abdomen/ suprapubic discomfort.
urine output less than 300cc
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Admit for urosepsis, malignancy, acute myelopathy, acute renal
failure.
400cc leave cath in place
Most common UTI organism - ANSWER e. coli, pseudomonas,
klebsiella, staphylococci, candida
Urine Dipstick - ANSWER Screening test for infection with some
limitations in diagnostic value
- Best paired with clinical history / findings
- Negative findings does not necessarily rule out
infection in symptomatic patient
- Lower detection of infection for some parameters
• Key Findings
- Leukocyte esterase (presence)
- Nitrates (presence)
- Blood (≥ 1+)
- Protein (≥ 3+)
Urine Microscopy (UA) - ANSWER Key findings
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• Pyuria
- WBCs or pus
- Cloudy urine is not necessarily pyuria
- Supports diagnosis of UTI but can have other causes and
negative
results do not rule out trial of empiric antibiotics in clinically
likely UTI
• WBCs
- > 5 WBCs per HPF suggests infection
• Alternatively 8,000-10,000 / mL or 8 -10 per uL (note different
units)
- WBC casts indicate inflammation that may or may not be
infectious
• Bacteria
- Bacteria in any amount suggests infection
- Bacteria without pyuria can be contamination
• RBC's
- > 5 RBC's per HPF
• Elevated epithelial cells can suggest contamination
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• Low bacterial count may be associated with antibiotic
exposure,
urine dilution
Uncomplicated Acute Cystitis treatment - ANSWER Cephalexin,
nitrofurantoin or trimethoprimsulfamethoxazole
- Sulfa allergy: Ciprofloxacin
Acute Pyelonephritis treatment - ANSWER • 7-14 days therapy
(non-pregnant)
- 14 for inpatient
• Empiric first line options (examples)
- Oral: Ciprofloxacin, levofloxacin or
trimethoprimsulfamethoxazole
• Allergy -Bactrim or beta lactam
- Inpatient: IV ampicillin + aminoglycoside
• Consider imaging if fever persists > 48 hrs
• Follow-up culture after treatment
• Tailor to culture results, when available
Nurs 640 Exam 4 Latest Update ) Exam | Questions and
Verified Answers | 100% Correct | Grade A +
Hematuria - ANSWER work up: infection/anticoagulation
Urinary stone disease - ANSWER most common Ca
s/s: hematuria/ severe colic, acute flank pain, N&V
Testing: Ultrasound or spiral non contract CT.
BPH (benign prostatic hyperplasia) - ANSWER noncancerous
enlargement of the prostate
s/s hesitancy
DRE (digital rectal exam): enlarged prostate.
Med: alpha blockers
procedures: TURP
Acute Urinary retention - ANSWER cause: BPH or medication
S/S: lower abdomen/ suprapubic discomfort.
urine output less than 300cc
,2|Page
Admit for urosepsis, malignancy, acute myelopathy, acute renal
failure.
400cc leave cath in place
Most common UTI organism - ANSWER e. coli, pseudomonas,
klebsiella, staphylococci, candida
Urine Dipstick - ANSWER Screening test for infection with some
limitations in diagnostic value
- Best paired with clinical history / findings
- Negative findings does not necessarily rule out
infection in symptomatic patient
- Lower detection of infection for some parameters
• Key Findings
- Leukocyte esterase (presence)
- Nitrates (presence)
- Blood (≥ 1+)
- Protein (≥ 3+)
Urine Microscopy (UA) - ANSWER Key findings
,3|Page
• Pyuria
- WBCs or pus
- Cloudy urine is not necessarily pyuria
- Supports diagnosis of UTI but can have other causes and
negative
results do not rule out trial of empiric antibiotics in clinically
likely UTI
• WBCs
- > 5 WBCs per HPF suggests infection
• Alternatively 8,000-10,000 / mL or 8 -10 per uL (note different
units)
- WBC casts indicate inflammation that may or may not be
infectious
• Bacteria
- Bacteria in any amount suggests infection
- Bacteria without pyuria can be contamination
• RBC's
- > 5 RBC's per HPF
• Elevated epithelial cells can suggest contamination
, 4|Page
• Low bacterial count may be associated with antibiotic
exposure,
urine dilution
Uncomplicated Acute Cystitis treatment - ANSWER Cephalexin,
nitrofurantoin or trimethoprimsulfamethoxazole
- Sulfa allergy: Ciprofloxacin
Acute Pyelonephritis treatment - ANSWER • 7-14 days therapy
(non-pregnant)
- 14 for inpatient
• Empiric first line options (examples)
- Oral: Ciprofloxacin, levofloxacin or
trimethoprimsulfamethoxazole
• Allergy -Bactrim or beta lactam
- Inpatient: IV ampicillin + aminoglycoside
• Consider imaging if fever persists > 48 hrs
• Follow-up culture after treatment
• Tailor to culture results, when available
