NR 507 Final Exam (2025 / 2026) Advanced Pathophysiology Questions & Verified Answers, Exams of Pathophysiology

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NR507 Advanced Pathophysiology

Final Exam Week 8 Exam

Questions and Rationalized Answers Guarantee passing score

This exam features: multiple-choice ques & Ans

1. Which of the following is true regarding a complicated urinary tract infec- tion?

It is usually asymptomatic Bacteria is located mostly in the lower urinary tract Can be caused by a structural urinary tract disorder Is associated with young adults : Ans>> Can be caused by a structural urinary tract disorder

A complicated UTI can be caused by a structural issue in the urinary tract.

2. Which of the following is a risk factor for the development of a urinary tract infection (UTI)?

Marathon running Frequent showering Perimenopause Pregnancy : Ans>> Pregnancy

Pregnancy is a risk factor the development of a UTI.

3. Which of the following can help to prevent a UTI?

Douching to prevent the growth of bacteria Increase water consumption Taking more Vitamin D Use spermicides during sexual intercourse: Ans>> Increase water consumption

Water consumption prevents UTI as it keeps bacteria flushed out of the urinary tract.

4. Women are at a higher risk for the development of a UTI because of having a shorter urethra.

True False: Ans>> True

WBCs: + >5000/hhpf Casts: None

9. Complicated UTI Labs:: Protein: + or - Leukocyte Esterase: + Nitrites: + or - RBCs: + WBCs: + >100,000/hhpf Casts: +
10. RBCs (red blood cells) in a urine sample:: greater than 3 RBCs/hpf is con- sidered abnormal. Abnormal morphology of the RBC strongly suggests glomerular disease. RBCs are often present with a UTI (hematuria).
11. WBC's in a urine sample:: greater than 5 WBCs/hpf is considered abnormal. These will be present in a UTI. Bacteria: will be present
12. Crystals in a urine sample:: these are microscopic solids composed of a small number of different ions and molecules. These are common in the urine and if they remain small, are not pathologic.
13. Casts in a urine sample:: are long cylindrical structures formed in the renal tubules due to the precipitation of Tamm-Horsfall mucoprotein. It is the most abun- dant protein excreted by the urine. Casts form in concentrated and/or acidic urine. The most common casts are hyaline casts that only consist of Tamm-Horsfall protein without other constituents. They are non-specific and may be seen in dehydration. Muddy brown

casts suggest acute tubular necrosis. Waxy casts are suggestive of acute and chronic renal failure. Fatty casts are suggestive of nephrotic syndrome;

Because of his confusion and fall, he was transferred to the acute care facility for evaluation and treatment. Lab work revealed that the patient was very dehydrated with hypernatremia identified and appropriate intravenous fluids started.

Cystitis was also identified from the urinalysis. He was also noted to have red and excoriated skin between the buttocks and inner thighs due to urinary frequency and dribbling.To help with skin healing and to prevent further urine leakage, an indwelling catheter was inserted. Two days 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: Urinary obstruction Pyelonephritis Glomerulonephritis Simple UTI: Ans>> Pyelonephritis

16. Identify the major risk factor J.S. has that is associated with pyelonephritis:

Dehydration Fever Flank pain Indwelling Foley catheter : Ans>> Indwelling foley catheter

The major risk factor for the development of pyelonephritis in this patient is the indwelling Foley catheter. Flank pain, dehydration and fever are symptoms rather than risk factors.

17. 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: Ans>> True

causative bacteria are gram negative because of the presence of:

RBCs. Nitrites. WBCs. Casts Ans>> Nitrites

The presence of nitrites indicates that the causative bacteria is gram-negative.

22. The peripheral zone of the prostate is the largest zone.

True False: True

Anatomically, the peripheral zone is the largest one.

23. The purpose of straining in BPH is to overcome the obstruction encoun- tered during urination.

True False: True

The individual strains to overcome the obstruction in order to release the urine.

24. On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings?

A rubber-like quality of the prostate. A lack of pain on palpation. A soft-smooth prostate. A hard nodule Ans>> A hard nodule

A hard nodule can indicate prostate cancer.

25. There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer.

True False: False

26. The patient most often develops symptoms of BPH when:

The patient's PSA becomes elevated. The prostatic urethra becomes obstructed. A nodule forms on the prostate. The bladder becomes obstructed Ans>> The prostatic urethra becomes obstructed.

The cause of symptoms of BPH relates to the constriction of the prostatic urethra obstruction that affects that passage of urine.

27. The prostate specific antigen (PSA) helps to liquefy semen post-ejacula- tion.

This statement is true. The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply.

30. The location of the characteristic hyperplastic nodules of BPH is:

In the periurethral zone. In the zone immediately inside the rectum. In the posterior prostate. In the anterior prostate zone Ans>> In the periurethral zone.

Prostate nodules are usually located in the periurethral zone.

31. Men who have BPH are prone to developing a UTI because:

The prostate is not a sterile environment. Ingested fluids do not adequately flush the kidneys. Stagnated urine in the bladder promotes bacterial growth. They have a low WBC count due to an infected prostate Ans>> Stagnated urine in the bladder promotes bacterial growth.

Stagnation of urine in the bladder promotes bacterial growth which can lead to a UTI.

32. The gold standard for diagnosing a renal stone is a urinalysis.

True

False: False

The gold standard for diagnosing a renal stone is CT scan.

33. Renal stones are formed when calcium and oxalate in the urine combine.

True False: True

Stones form when calcium and oxalate in the urine combine.

34. Renal calculi are typically confined to the bladder.

True False: False

Renal calculi can be found in the ureter or bladder.

38. Struvite stone:: This type of stone occurs due to a urinary tract infection, most often by proteus, klebsiella and serratia and enterobacter species. Ammonium, magnesium, and phosphate form to create the stone. The bacteria contribute to the stone formation through the production of the enzyme, urease. Urea, in the presence of urease converts to ammonia and a byproduct of CO2. This makes the urine alkaline which favors stone formation. Another name for this stone is the Staghorn stone. It obstructs the renal calyx. The location of the Staghorn stone is shown in the diagram below. The stone is given its name because of it contains irregular, horn-like structures.
39. Uric acid stone: This is the type of stone that is found in a patient with gout. There is an increase in uric acid. Individuals who are at risk for getting gout include those with leukemia and myeloproliferative disorder; those undergoing chemothera- py. Chemotherapy destroys the cancer cells. DNA cells contain purine. When broken down, purine will increase uric acid levels that can lead to uric acid stone formation. Uric acid increases the acidity of the urine with resultant decrease in urine pH.

Uric acid stones are radiolucent, meaning that the stones cannot be seen on x-ray. Treatment includes hydration and increasing the alkaline of the urine by giving potassium bicarbonate. Individuals will also be prescribed allopurinol, an anti-gout medication.

40. Cystine stone:: This is a rare type of kidney stone that is found mostly in children. It is caused by a genetic renal tubule defect that prevents the amino acid, cystine, from being reabsorbed that leads to the formation of a cystine stone. This stone can also from Staghorn shaped stones.
41. A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10- RBCs per high-power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone.

Upon follow-up in the office a week later, the patient reported that he was diagnosed with a kidney stone, but he was not aware of the type of stone or the cause for it. He was very concerned about why he had the associated severe flank pain and asked the NP why the pain was so severe and how could he avoid another stone in the future.

A balanced diet Calcium restriction: Adequate hydration A balanced diet

The NP should encourage him to maintain adequate hydration. If possible, the patient can be encouraged to drink at least 2 liters of water/day to prevent calci- um precipitation. A high-protein diet promotes stone formation in some patients. Therefore, the NP encourages the patient to maintain a balanced diet. In addition, a high-sodium diet should be avoided because it predisposes to calcium excretion and increases the saturation of monosodium urate, which promotes calcium stone formation. Calcium restriction is not recommended because it can increase oxalate absorption and decrease urinary excretion of calcium.

42. Lithotripsy is an invasive procedure used to break up the stone

True False: False

Lithotripsy, is a non-invasive procedure and will be performed if the stone lodges on the way out.

43. Hematuria can be seen with kidney stones because:

The stone creates its own blood supply around it. As WBCs increase, the RBCs also increase. The stone injures the urinary structures as it passes through them.

The patient becomes anemic when stones form Ans>> The stone injures the urinary structures as it passes through them.

The passing of the stone through the renal structures become damaged and results in hematuria.

44. The most common stone found in the patient with gout is:

Cystine stone. Struvite stone. Calcium stone. Uric acid stone Ans>> Uric acid stone.

The most common stone found in the patient with gout is uric acid stone.

45. At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone.