FINAL EXAM - NR507 (LATEST 2023 / 2024): ADVANCED PATHOPHYSIOLOGY COMPLETE QUESTIONS WITH ANSWERS. (2025)

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• Course Pathophysiology

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FINAL EXAM - NR507 (LATEST ): ADVANCED PATHOPHYSIOLOGY
COMPLETE QUESTIONS WITH ANSWERS.

“Renal System - CORRECT ANSWER ..."

"Urinary Tract pre-quiz Q's - CORRECT ANSWER ...."

"1. What are the two main functions of the kidney Review diagram for anatomical structures -
CORRECT ANSWER 1. Filtration and collection"

"Which of the following is a risk factor for the development of a urinary tract infection (UTI)?
Perimenopause
Frequent showering
Marathon running
Pregnancy - CORRECT ANSWER Pregnancy"

"1. Where do bacteria commonly come from in UTI's
2. Where can a UTI occur?
3. It is more common for women to develop a UTI especially when - CORRECT ANSWER 1.
Bacteria from the gut can invade the urinary epithelium to cause inflammation and infection
2. anywhere along the urinary tract such as the urethra, bladder, ureter, or kidney
3. pregnant, sexually active, during post-menopause with estrogen-deficiency and when being
treated with antibiotics where the normal bacteria flora is diminished"

"1. Escherichia coli can bind to cells in the lower urinary tract and hide from the immune cells.
The bacteria can form biofilms-what is this?
2. Describe the pathophysiology of a UTI that can lead to septic shock or bacterimia
Note the diagram btw a male & female urinary tracts (who's is much shorter) - CORRECT
ANSWER 1. A biofilm is any group of microorganisms that allow them to stick to one another
and adhere to surfaces that help them survive.
2. First, bacteria enter and contaminate the lower urinary tract. This causes the colonization of
bacteria in the urethra and the bladder. If the UTI progresses the bacteria can ascend to the
kidneys and colonize there. At this point, the infection becomes an upper UTI. From there, if left
untreated, the bacteria can spread into the circulation via the renal veins causing bacteremia"

"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

1

,4. Sexual intercourse is a risk factor especially if women use
5. Indwelling urinary catheterization is also a major cause of a UTI - CORRECT 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 - CORRECT 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"

"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 - CORRECT 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

2

,4. A UTI that extends beyond
5. Caused by
6. Infants and
7. Associated with: - CORRECT 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 - CORRECT 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 - CORRECT 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 -

3

, 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"

"RBCs (red blood cells): greater than 3 RBCs/hpf is considered abnormal. Abnormal morphology
of the RBC strongly suggests - CORRECT 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 - CORRECT 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 - CORRECT ANSWER ..."

"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 - CORRECT ANSWER a. Pyelonephritis"

"Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are
gram negative because of the presence of:

4