NR 661 Urology Exam (2026/2027) |
Complete Primary Care Urologic Disorders
Guide with Verified
Q&A Management Strategies
A 44-year-old female patient is diagnosed with a urinary tract infection (UTI). Which bacteria
count collected via midstream, clean catch supports a diagnosis of UTI?
a. > 10,000 bacteria
b. >25,000 bacteria
c. >50,000 bacteria
d. >100,000 bacteria
Answer: d. >100,000 bacteria
Expert Rationale
A urine culture obtained via midstream, clean-catch technique showing greater than 100,000
colony-forming units (CFU) per mL of a single uropathogen is the standard diagnostic criterion for a
urinary tract infection (UTI). This threshold, known as Kass' criteria, differentiates true infection
from contamination. In symptomatic patients, lower colony counts (10,000–100,000 CFU/mL) may
also be significant, particularly in men or if the specimen was obtained via catheterization.
However, the classic diagnostic threshold for an uncomplicated UTI in a female patient is >100,000
CFU/mL. Options A, B, and C represent lower bacterial counts that may indicate contamination or a
less significant infection. The NP should correlate colony counts with clinical symptoms (dysuria,
frequency, urgency) and urinalysis findings (leukocyte esterase, nitrites, pyuria) to confirm the
diagnosis and guide antibiotic selection.
,DIF: Cognitive Level: Remember (Knowledge) TOP: Urinary Tract Infection Diagnosis MSC: NCLEX:
Physiological Integrity
A patient has been diagnosed with pyelonephritis. He probably will have:
a. costovertebral angle tenderness
b. a positive Murphy's sign
c. burning with urination
d. pain which waxes and wanes
Answer: a. costovertebral angle tenderness
Expert Rationale
Pyelonephritis is an infection of the renal parenchyma and renal pelvis, typically caused by
ascending bacteria from the lower urinary tract. The classic physical examination finding in
pyelonephritis is costovertebral angle (CVA) tenderness, which is elicited by percussion over the
angle between the 12th rib and the spine. CVA tenderness indicates inflammation of the kidney
and surrounding tissues. Option B (positive Murphy's sign) is associated with gallbladder disease
(cholecystitis), not pyelonephritis. Option C (burning with urination) is a symptom of cystitis (lower
UTI) and may accompany pyelonephritis but is not the hallmark finding. Option D (pain which
waxes and wanes) is more characteristic of renal colic from urolithiasis (kidney stones). The NP
should assess for CVA tenderness, fever, chills, nausea, and vomiting in patients with suspected
pyelonephritis and initiate prompt antibiotic therapy.
DIF: Cognitive Level: Apply (Application) TOP: Pyelonephritis Diagnosis MSC: NCLEX: Physiological
Integrity
A patient has a urinary tract infection. What findings on urine dipstick best describes a typical
urinary tract infection?
a. positive leukocytes
b. positive nitrates
c. positive leukocytes, positive nitrates
d. positive nitrates and hematuria
Answer: c. positive leukocytes, positive nitrates
Expert Rationale
A typical urinary tract infection (UTI) on urine dipstick is characterized by the presence of both
positive leukocyte esterase (indicating white blood cells/pyuria) and positive nitrites (indicating the
presence of nitrate-reducing bacteria, most commonly Escherichia coli). The combination of these
two findings provides strong evidence of a bacterial UTI. Option A (positive leukocytes alone)
suggests inflammation but could be due to other causes (e.g., interstitial cystitis, stones). Option B
(positive nitrates alone) may be seen but is less sensitive, as not all bacteria reduce nitrates. Option
D (positive nitrates and hematuria) is less specific; hematuria may be present in UTIs but can also
indicate stones, trauma, or malignancy. The NP should interpret dipstick results in conjunction with
clinical symptoms and, when indicated, order a urine culture for confirmation and susceptibility
,testing.
DIF: Cognitive Level: Understand (Comprehension) TOP: Urinary Tract Infection Diagnosis MSC:
NCLEX: Physiological Integrity
A 26 year old female presents with flank pain that waxes and wanes. What finding on urinalysis
should direct the nurse practitioner's next action?
a. Blood
b. Nitrates
c. Leukocytes
d. Calcium
Answer: a. Blood
Expert Rationale
Flank pain that waxes and wanes (colicky pain) is characteristic of renal colic due to urolithiasis
(kidney stones). The presence of blood (hematuria) on urinalysis is the key finding that supports
this diagnosis and directs the NP's next action, which is to evaluate for nephrolithiasis with
appropriate imaging (non-contrast CT or renal ultrasound). Option B (Nitrates) indicates bacterial
infection, which is less likely given the classic waxing and waning pain pattern. Option C
(Leukocytes) suggests infection or inflammation but is not as specific for stones as hematuria.
Option D (Calcium) is not a standard urinalysis finding; 24-hour urine calcium may be measured for
stone risk assessment. The NP should recognize renal colic as a likely diagnosis, order imaging to
confirm the presence and size of stones, and provide appropriate pain management and urology
referral.
DIF: Cognitive Level: Apply (Application) TOP: Urolithiasis Diagnosis MSC: NCLEX: Physiological
Integrity
How long should a female patient with an uncomplicated UTI be treated with an oral antibiotic?
a. 1 day
b. 3 days
c. 5 days
d. 7 days
Answer: b. 3 days
Expert Rationale
For an uncomplicated urinary tract infection (UTI) in a non-pregnant female, a 3-day course of oral
antibiotics is the recommended duration of therapy. Short-course therapy (3 days) has been shown
to be as effective as longer courses (5–7 days) for uncomplicated UTIs, with improved compliance
and reduced side effects. The most commonly recommended antibiotics include nitrofurantoin (5
days), trimethoprim-sulfamethoxazole (3 days), or fosfomycin (single dose), depending on local
resistance patterns. Option A (1 day) is insufficient for most antibiotics, although fosfomycin is a
single-dose option. Option C (5 days) is appropriate for nitrofurantoin but not the standard for all
antibiotics. Option D (7 days) is longer than necessary for uncomplicated UTI and may increase the
, risk of side effects and antibiotic resistance. The NP should base the antibiotic choice and duration
on the patient's history, local resistance patterns, and specific antibiotic used.
DIF: Cognitive Level: Remember (Knowledge) TOP: Urinary Tract Infection Treatment MSC: NCLEX:
Pharmacological and Parenteral Therapies
An adolescent has suspected varicocele. He has dull scrotal pain that is relieved by:
a. standing
b. recumbency
c. having a bowel movement
d. elevation of the testicle
Answer: b. recumbency
Expert Rationale
A varicocele is an abnormal dilation of the pampiniform venous plexus in the scrotum, similar to
varicose veins in the leg. It typically presents as a dull, aching scrotal pain that is often described as
a "bag of worms." The pain is characteristically relieved by recumbency (lying down) because the
supine position reduces venous pressure and allows the dilated veins to empty. Option A (Standing)
typically worsens the pain due to increased hydrostatic pressure. Option C (Having a bowel
movement) is not associated with varicocele relief. Option D (Elevation of the testicle) is a
maneuver that relieves pain in testicular torsion (Prehn's sign), not varicocele. The NP should
perform a physical examination with the patient standing and supine to assess for varicocele, and
consider scrotal ultrasound to confirm the diagnosis if indicated.
DIF: Cognitive Level: Understand (Comprehension) TOP: Varicocele Assessment MSC: NCLEX:
Physiological Integrity
A 70 year old male patient is diagnosed with renal disease. Which activity will help preserve
kidney function?
a. 20 minutes of daily exercise
b. daily increase in water consumption
c. daily weights
d. avoidance of red meat
Answer: b. daily increase in water consumption
Expert Rationale
Increasing daily water consumption is one of the most important interventions to help preserve
kidney function in patients with renal disease. Adequate hydration helps maintain renal perfusion,
promotes excretion of waste products and toxins, reduces the concentration of nephrotoxic
substances in the urine, and may help prevent further kidney injury. Option A (20 minutes of daily
exercise) is beneficial for overall health but does not directly preserve kidney function. Option C
(Daily weights) is important for monitoring fluid status but does not preserve kidney function.
Option D (Avoidance of red meat) may be recommended in some patients to reduce protein load,
but hydration is a more fundamental and universal recommendation. The NP should educate
Complete Primary Care Urologic Disorders
Guide with Verified
Q&A Management Strategies
A 44-year-old female patient is diagnosed with a urinary tract infection (UTI). Which bacteria
count collected via midstream, clean catch supports a diagnosis of UTI?
a. > 10,000 bacteria
b. >25,000 bacteria
c. >50,000 bacteria
d. >100,000 bacteria
Answer: d. >100,000 bacteria
Expert Rationale
A urine culture obtained via midstream, clean-catch technique showing greater than 100,000
colony-forming units (CFU) per mL of a single uropathogen is the standard diagnostic criterion for a
urinary tract infection (UTI). This threshold, known as Kass' criteria, differentiates true infection
from contamination. In symptomatic patients, lower colony counts (10,000–100,000 CFU/mL) may
also be significant, particularly in men or if the specimen was obtained via catheterization.
However, the classic diagnostic threshold for an uncomplicated UTI in a female patient is >100,000
CFU/mL. Options A, B, and C represent lower bacterial counts that may indicate contamination or a
less significant infection. The NP should correlate colony counts with clinical symptoms (dysuria,
frequency, urgency) and urinalysis findings (leukocyte esterase, nitrites, pyuria) to confirm the
diagnosis and guide antibiotic selection.
,DIF: Cognitive Level: Remember (Knowledge) TOP: Urinary Tract Infection Diagnosis MSC: NCLEX:
Physiological Integrity
A patient has been diagnosed with pyelonephritis. He probably will have:
a. costovertebral angle tenderness
b. a positive Murphy's sign
c. burning with urination
d. pain which waxes and wanes
Answer: a. costovertebral angle tenderness
Expert Rationale
Pyelonephritis is an infection of the renal parenchyma and renal pelvis, typically caused by
ascending bacteria from the lower urinary tract. The classic physical examination finding in
pyelonephritis is costovertebral angle (CVA) tenderness, which is elicited by percussion over the
angle between the 12th rib and the spine. CVA tenderness indicates inflammation of the kidney
and surrounding tissues. Option B (positive Murphy's sign) is associated with gallbladder disease
(cholecystitis), not pyelonephritis. Option C (burning with urination) is a symptom of cystitis (lower
UTI) and may accompany pyelonephritis but is not the hallmark finding. Option D (pain which
waxes and wanes) is more characteristic of renal colic from urolithiasis (kidney stones). The NP
should assess for CVA tenderness, fever, chills, nausea, and vomiting in patients with suspected
pyelonephritis and initiate prompt antibiotic therapy.
DIF: Cognitive Level: Apply (Application) TOP: Pyelonephritis Diagnosis MSC: NCLEX: Physiological
Integrity
A patient has a urinary tract infection. What findings on urine dipstick best describes a typical
urinary tract infection?
a. positive leukocytes
b. positive nitrates
c. positive leukocytes, positive nitrates
d. positive nitrates and hematuria
Answer: c. positive leukocytes, positive nitrates
Expert Rationale
A typical urinary tract infection (UTI) on urine dipstick is characterized by the presence of both
positive leukocyte esterase (indicating white blood cells/pyuria) and positive nitrites (indicating the
presence of nitrate-reducing bacteria, most commonly Escherichia coli). The combination of these
two findings provides strong evidence of a bacterial UTI. Option A (positive leukocytes alone)
suggests inflammation but could be due to other causes (e.g., interstitial cystitis, stones). Option B
(positive nitrates alone) may be seen but is less sensitive, as not all bacteria reduce nitrates. Option
D (positive nitrates and hematuria) is less specific; hematuria may be present in UTIs but can also
indicate stones, trauma, or malignancy. The NP should interpret dipstick results in conjunction with
clinical symptoms and, when indicated, order a urine culture for confirmation and susceptibility
,testing.
DIF: Cognitive Level: Understand (Comprehension) TOP: Urinary Tract Infection Diagnosis MSC:
NCLEX: Physiological Integrity
A 26 year old female presents with flank pain that waxes and wanes. What finding on urinalysis
should direct the nurse practitioner's next action?
a. Blood
b. Nitrates
c. Leukocytes
d. Calcium
Answer: a. Blood
Expert Rationale
Flank pain that waxes and wanes (colicky pain) is characteristic of renal colic due to urolithiasis
(kidney stones). The presence of blood (hematuria) on urinalysis is the key finding that supports
this diagnosis and directs the NP's next action, which is to evaluate for nephrolithiasis with
appropriate imaging (non-contrast CT or renal ultrasound). Option B (Nitrates) indicates bacterial
infection, which is less likely given the classic waxing and waning pain pattern. Option C
(Leukocytes) suggests infection or inflammation but is not as specific for stones as hematuria.
Option D (Calcium) is not a standard urinalysis finding; 24-hour urine calcium may be measured for
stone risk assessment. The NP should recognize renal colic as a likely diagnosis, order imaging to
confirm the presence and size of stones, and provide appropriate pain management and urology
referral.
DIF: Cognitive Level: Apply (Application) TOP: Urolithiasis Diagnosis MSC: NCLEX: Physiological
Integrity
How long should a female patient with an uncomplicated UTI be treated with an oral antibiotic?
a. 1 day
b. 3 days
c. 5 days
d. 7 days
Answer: b. 3 days
Expert Rationale
For an uncomplicated urinary tract infection (UTI) in a non-pregnant female, a 3-day course of oral
antibiotics is the recommended duration of therapy. Short-course therapy (3 days) has been shown
to be as effective as longer courses (5–7 days) for uncomplicated UTIs, with improved compliance
and reduced side effects. The most commonly recommended antibiotics include nitrofurantoin (5
days), trimethoprim-sulfamethoxazole (3 days), or fosfomycin (single dose), depending on local
resistance patterns. Option A (1 day) is insufficient for most antibiotics, although fosfomycin is a
single-dose option. Option C (5 days) is appropriate for nitrofurantoin but not the standard for all
antibiotics. Option D (7 days) is longer than necessary for uncomplicated UTI and may increase the
, risk of side effects and antibiotic resistance. The NP should base the antibiotic choice and duration
on the patient's history, local resistance patterns, and specific antibiotic used.
DIF: Cognitive Level: Remember (Knowledge) TOP: Urinary Tract Infection Treatment MSC: NCLEX:
Pharmacological and Parenteral Therapies
An adolescent has suspected varicocele. He has dull scrotal pain that is relieved by:
a. standing
b. recumbency
c. having a bowel movement
d. elevation of the testicle
Answer: b. recumbency
Expert Rationale
A varicocele is an abnormal dilation of the pampiniform venous plexus in the scrotum, similar to
varicose veins in the leg. It typically presents as a dull, aching scrotal pain that is often described as
a "bag of worms." The pain is characteristically relieved by recumbency (lying down) because the
supine position reduces venous pressure and allows the dilated veins to empty. Option A (Standing)
typically worsens the pain due to increased hydrostatic pressure. Option C (Having a bowel
movement) is not associated with varicocele relief. Option D (Elevation of the testicle) is a
maneuver that relieves pain in testicular torsion (Prehn's sign), not varicocele. The NP should
perform a physical examination with the patient standing and supine to assess for varicocele, and
consider scrotal ultrasound to confirm the diagnosis if indicated.
DIF: Cognitive Level: Understand (Comprehension) TOP: Varicocele Assessment MSC: NCLEX:
Physiological Integrity
A 70 year old male patient is diagnosed with renal disease. Which activity will help preserve
kidney function?
a. 20 minutes of daily exercise
b. daily increase in water consumption
c. daily weights
d. avoidance of red meat
Answer: b. daily increase in water consumption
Expert Rationale
Increasing daily water consumption is one of the most important interventions to help preserve
kidney function in patients with renal disease. Adequate hydration helps maintain renal perfusion,
promotes excretion of waste products and toxins, reduces the concentration of nephrotoxic
substances in the urine, and may help prevent further kidney injury. Option A (20 minutes of daily
exercise) is beneficial for overall health but does not directly preserve kidney function. Option C
(Daily weights) is important for monitoring fluid status but does not preserve kidney function.
Option D (Avoidance of red meat) may be recommended in some patients to reduce protein load,
but hydration is a more fundamental and universal recommendation. The NP should educate
