mam phys ch 25
1) If the GFR is too low, needed substances may pass so quickly through the renal tubules that they are not absorbed and instead are lost in the urine.
f
11) The collecting duct is impermeable to water in the presence of ADH.
f
13) Angiotensin II is a substance made by the body to lower blood pressure during stress.
f
15) Blood pressure in the renal glomerulus is lower than in most parts of the body in order to conserve body water.
f
16) The proximal convoluted tubule is the portion of the nephron that attaches to the collecting duct.
f
17) Urea is reabsorbed in the nephron loop.
f
19) The myogenic mechanism reflects the tendency of vascular smooth muscle to stretch.
f
20) An excessive urine output is called anuria.
f
22) The trigone is so named because of the shape of the urinary bladder.
f
24) The macula densa cells are chemoreceptors that respond to changes in the urea content of the filtrate.
f
27) Having a kinked ureter is called renal ptosis.
f
28) Fetal kidneys have the primary responsibility of clearing wastes from the fetal blood.
f
3) The path urine takes after it is formed until it leaves the body is the urethra, urinary bladder, and finally the ureter.
f
7) Both the male and female urethras serve both the urinary and the reproductive systems.
f
9) Glomerular filtration is an ATP-driven process.
f
3) The area between the ureters and urethra is that is often the location of infection is called the ________ in a bladder.
trigone
8) The act of emptying the bladder is called voiding.
t
10) Explain what is meant by the terms cotransport process and transport maximum.
Cotransport process refers to the active transport of one solute "uphill" (against a concentration gradient) coupled to the "downhill" (with a concentration gradient) movement of another during tubular reabsorption. Transport maximum reflects the number of carriers in the renal tubules available to "ferry" a particular substance.
3) Ellen, a 47-year-old woman who has suffered kidney disease for several years, has been diagnosed with proteinuria. Her legs and feet are so swollen that she has difficulty walking. Her hands and her left arm are also swollen. What is proteinuria, and could this condition be playing a role in her swollen limbs?
Proteinuria is a condition in which the permeability of the glomerular capillaries is increased to such an extent that large amounts of plasma proteins (mostly albumin) pass into the glomerular filtrate and are excreted in the urine. If the condition is severe, the loss of plasma proteins may decrease osmotic pressure substantially. When this happens there is a tendency for fluid to leave the systemic blood vessels and enter the tissue space. This is the reason for Ellen's swollen limbs.
8) List three substances that are abnormal urinary constituents and provide the proper clinical term for such abnormalities.
Abnormal urinary constituents include the following (the clinical term for each is listed in parentheses): glucose (glycosuria), proteins (proteinuria or albuminuria), ketone bodies (ketonuria), hemoglobin (hemoglobinuria), bile pigments (bilirubinuria), erythrocytes (hematuria), and leukocytes (pyuria).
9) Explain the role of aldosterone in sodium and water balance.
Aldosterone targets the distal tubule and collecting duct and enhances sodium ion reabsorption so that very little leaves the body in urine. Aldosterone also causes increased water reabsorption because, as sodium is reabsorbed, water follows it back into the blood.
6) Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective as an antihypertensive.
Angiotensin II is a potent vasoconstrictor activating smooth muscle of arterioles throughout the body, causing mean arterial blood pressure to rise. ACE inhibitors reduce blood pressure by interrupting the renin-angiotensin-aldosterone system.
11) What are aquaporins?
Aquaporins are transmembrane proteins that form water-filled pores in water-permeable portions of the convoluted tubules such as the PCT and collecting duct.
4) An 18 year old patient has a complaint of painful urination, fever, chills, and back pain. This is her second urinary tract infection (UTI) within 5 months. How can the RN instruct the patient on prevention of another UTI?
Escherichia coli are normal residents of the digestive tract and generally cause no problems there, but these bacteria account for 80% of all urinary tract infections. The nurse can instruct the patient on proper hygiene measures, including wiping from front to back following urination to avoid introduction of anal bacteria, reduction in sexual activity if sexually active, and increased fluid intake to increase flushing of the urethra. The nurse should also explain that sexually transmitted infections can also inflame the urinary tract, clogging some of its ducts.
2) Eleven-year-old Harry is complaining of a severe sore throat and gets to stay home from school. His pediatrician prescribes a course of broad-spectrum antibiotics, and Harry feels much better within a few days. However, some two weeks later, Harry has a dull, bilateral pain in his lower back and his urine is a smoky brown color. On the basis of Harry's signs and symptoms, diagnose his condition and indicate the relationship (if any) between his present condition and his earlier sore throat.
Harry is showing the symptoms of kidney inflammation. Kidney inflammations usually result from infections either of the lower urinary tract or, in Harry's case, from his earlier infection of a sore throat. Streptococcal infection of the throat can induce anti-streptococcal antibodies that bind to them, depositing immune complexes in the glomerular membranes. The kidney inflammation that primarily involves glomeruli is called glomerulonephritis, and if severe enough can cause permanent renal failure. In post-streptococcal glomerulonephritis, the smoky brown color of urine most commonly represents the leakage of blood cells through the damaged glomerular membrane.
5) A 58-year-old woman complains of loss of urine when coughing and sneezing, and during exercise. She has had three children. Describe the possible causes of urinary incontinence in this patient.
Stress incontinence is found most commonly in women with relaxed pelvic musculature deprived of estrogen. Stress incontinence may occur with a sudden increase in intra-abdominal pressure such as coughing or sneezing, which forces urine through the external sphincter. Aging, multiple pregnancies, and obesity are risk factors in increasing the relaxation and/or pressure from above.
7) Explain how filtration works in the glomerular capillaries.
The glomerular capillaries are fenestrated, allowing fairly large molecules to pass through. The substances must pass through the basement membrane, where they are further selected for size by the filtration slits of the podocytes.
1) An older man sees his doctor for severe pain in his lower abdominal or flank area, elevated temperature, and nausea. Exhaustive tests rule out abdominal obstructions and infections. Plain X-rays indicate a radiopaque (whitish) spot in the area of his right ureter. Diagnose his problem. Give suggested treatment and prognosis.
The symptoms indicate a kidney stone that has been passed into the ureter. Recommended treatments include be IV therapy to flush the stone out, surgery, or ultrasound waves to shatter the calculi. The usual prognosis is for complete recovery. There is a possibility of kidney stones forming again.
12) If the glomerular mesangial cells contract, reducing the overall surface area of the glomerulus which of the following is not likely to occur? A) Systemic blood pressure will be lowered. B) Glomerular filtration rate will decrease. C) Net filtration rate will decrease. D) Urine output will decrease.
a
14) Which of the following statements best describes the difference between the intrinsic and extrinsic controls of the kidney? A) Extrinsic controls have the greatest effect on systemic blood pressure while intrinsic control have a greater effect on GFR. B) Extrinsic controls will reduce blood plasma volume while intrinsic controls will increase blood plasma volumes. C) Intrinsic controls raise blood pressure while extrinsic controls lower blood pressure. D) Extrinsic and intrinsic controls work in nearly opposite ways.
a
15) Reabsorption of nutrients like glucose and amino acids takes place in the proximal convoluted tubule (PCT) via cotransporters that utilize secondary active transport. Which of the following would stop the reabsorption of glucose at the apical surface of the cells in the PCT? A) loss of Na+-K+ ATPase in the basolateral surface of PCT cells B) loss of K+ leak channels at the apical surface C) increasing Na+ concentration in the filtrate D) increasing Na+ in the interstitial fluid
a
19) An increase in the permeability of the cells of the collecting tubule to water is due to a(n) ________. A) increase in the production of ADH B) decrease in the concentration of the blood plasma C) increase in the production of aldosterone D) decrease in the production of ADH
a
2) What is the best explanation for the microvilli on the apical surface of the proximal convoluted tubule (PCT)? A) They increase the surface area and allow for a greater volume of filtrate components to be reabsorbed. B) Their movements propel the filtrate through the tubules. C) They increase the amount of surface area that comes in contact with the blood's plasma to help activly excrete toxins. D) They hold on to enzymes that cleanse the filtrate before reabsorption.
a
20) The urinary bladder is composed of ________ epithelium. A) transitional B) stratified squamous C) pseudostratified columnar D) simple squamous
a
25) Select the correct statement about the ureters. A) The ureters are capable of peristalsis like that of the gastrointestinal tract. B) Ureters contain sphincters at the entrance to the bladder to prevent the backflow of urine. C) The ureter is innervated by parasympathetic nerve endings only. D) The epithelium is stratified squamous like the skin, which allows a great deal of stretch.
a
27) The functional and structural unit of the kidneys is the ________. A) nephron B) glomerular capsule C) nephron loop D) capsular space
a
33) Most electrolyte reabsorption by the renal tubules is ________. A) hormonally controlled in distal tubule segments B) not limited by a transport maximum C) in the distal convoluted tubule D) accomplished after the nephron loop is reached
a
45) Which of the choices below is a function of the nephron loop? A) form a large volume of very dilute urine or a small volume of very concentrated urine B) absorb electrolytes actively and water by osmosis in the same segments C) absorb water and electrolytes into the tubular network D) form a large volume of very concentrated urine or a small volume of very dilute urine
a
47) Which of the following best describes kidney function in older adults (70 years or older)? A) Kidney function decreases due to kidney atrophy. B) Only about 3% of older adults have any loss of kidney function. C) Only obese and diabetic older adults have any kidney dysfunction. D) Kidney function remains the same throughout life, regardless of age.
a
48) The factor favoring filtrate formation at the glomerulus is the ________. A) glomerular hydrostatic pressure B) myogenic mechanism C) capsular hydrostatic pressure D) colloid osmotic pressure of the blood
a
49) If the Tm for a particular amino acid is 120 mg/100 ml and the concentration of that amino acid in the blood is 230 mg/100 ml, the amino acid will ________. A) appear in the urine B) be completely reabsorbed by the tubule cells C) be actively secreted into the filtrate D) be completely reabsorbed by secondary active transport
a
50) If one says that the clearance value of glucose is zero, what does this mean? A) Normally all the glucose is reabsorbed. B) The clearance value of glucose is relatively high in a healthy adult. C) The glucose molecule is too large to be filtered out of the blood. D) Most of the glucose is filtered out of the blood and is not reabsorbed in the convoluted tubules.
a
51) Excretion of dilute urine requires ________. A) impermeability of the collecting tubule to water B) the presence of ADH C) relative permeability of the distal tubule to water D) transport of sodium and chloride ions out of the descending nephron loop
a
53) In the ascending limb of the nephron loop the ________. A) thick segment moves ions out into interstitial spaces for reabsorption B) thin segment is freely permeable to water C) thin segment is not permeable to sodium and chloride D) thick segment is permeable to water
a
58) Which of the choices below is not a glomerular filtration rate control method? A) electrolyte levels B) hormonal regulation C) renal autoregulation D) neural regulation
a
Match the following: A) Blood supply that directly receives substances from the tubular cells. B) Site of filtrate formation. C) Site that drains the distal convoluted tubule. D) Site at which most of the tubular reabsorption occurs 19) Peritubular capillaries.
a
Match the following: A) Glomerular capillaries B) Vasa recta C) Afferent arterioles D) Peritubular capillaries E) Efferent arterioles 25) Fenestrated vessels that allow passage of all plasma elements but not blood cells.
a
5) The presence of pus in the urine is a condition called ________.
pyuria
1) ADH activated water channels called ________ are essential for water reabsorption in the collecting duct.
aquaporins
1) Which of the following is the best explanation for why the cells of the proximal convoluted tubule (PCT) contain so many mitochondria? A) Cells of the PCT go through a great deal of mitosis. B) A great deal of active transport takes place in the PCT. C) Contraction of the PCT moves filtrate through the tubule. D) This provides the energy needed to fight kidney infection.
b
11) If the diameter of the efferent arterioles leading away from the glomerulus decrease (vasoconstriction) which of the following is not likely to occur? A) Urine output will increase. B) Systemic blood pressure will go up. C) Glomerular filtration rate will increase. D) Net filtration pressure will increase.
b
26) The fatty tissue surrounding the kidneys is important because it ________. A) produces vitamin D and other chemicals needed by the kidney B) stabilizes the position of the kidneys by holding them in their normal position C) is necessary as a barrier between the adrenal glands and kidneys D) ensures adequate energy for the adrenal glands to operate efficiently
b
28) Which of the following does not describe the justaglomerular complex? A) Its granular cells produce rennin. B) Its macula densa cells produce aldosterone. C) It helps control systemic blood pressure. D) It regulates the rate of filtrate formation.
b
29) The chief force pushing water and solutes out of the blood across the filtration membrane is ________. A) the ionic electrochemical gradient B) glomerular hydrostatic pressure (glomerular blood pressure) C) protein-regulated diffusion D) the size of the pores in the basement membrane of the capillaries
b
31) The filtration membrane includes all except ________. A) basement membrane B) renal fascia C) glomerular endothelium D) podocytes
b
37) Alcohol acts as a diuretic because it ________. A) is not reabsorbed by the tubule cells B) inhibits the release of ADH C) increases the rate of glomerular filtration D) increases secretion of ADH
b
40) Place the following in correct sequence from the formation of a drop of urine to its elimination from the body. 1. major calyx 2. minor calyx 3. nephron 4. urethra 5. ureter 6. collecting duct A) 6, 3, 2, 1, 5, 4 B) 3, 6, 2, 1, 5, 4 C) 3, 1, 2, 6, 5, 4 D) 2, 1, 3, 6, 5, 4
b
41) Select the correct statement about the nephrons. A) Podocytes are the branching epithelial cells that line the tubules of the nephron. B) The parietal layer of the glomerular capsule is simple squamous epithelium. C) The glomerulus is correctly described as the proximal end of the proximal convoluted tubule. D) Filtration slits are the pores that give fenestrated capillaries their name.
b
42) What would happen if the capsular hydrostatic pressure were increased above normal? A) Capsular osmotic pressure would compensate so that filtration would not change. B) Net filtration would decrease. C) Net filtration would increase above normal. D) Filtration would increase in proportion to the increase in capsular pressure.
b
44) Which of the following is not true regarding tubular reabsorption? A) It involves hormonal signals in the collecting ducts. B) It is a purely passive transport process. C) It is a reclamation process. D) It occurs via transcellular or paracellular routes.
b
5) The presence of protein in the urine indicates which of the following? A) too much protein in the diet B) damage to the filtration membrane C) high levels of transcription and translation by the bodies tissues D) damage to the renal tubules
b
55) What is the most direct function of the juxtaglomerular apparatus? A) help regulate blood pressure and the rate of excretion by the kidneys B) help regulate blood pressure and the rate of blood filtration by the kidneys C) help regulate water and electrolyte excretion by the kidneys D) help regulate urea absorption by the kidneys
b
6) Hydrostatic pressure is the primary driving force of plasma through the filtration membrane into the capsular space. All but one of the following statements reflects why hydrostatic pressure is so high in the glomerular capillaries. Select the one statement that does not explain the high pressure within the glomerular capillaries. A) The diameter of the efferent arteriole is smaller than the afferent arteriole. B) The volume of plasma in the efferent arteriole is higher when compared to the afferent arteriole. C) The efferent arteriole has higher resistance to blood flow than the afferent arteriole. D) The flow of blood is reduces as blood reaches the efferent arteriole.
b
7) Cells and transport proteins are physically prevented from passing through the filtration membrane. This has the following effect on filtration. A) decreased osmotic pressure in the filtrate that increases the amount of filtration B) increasing osmotic pressure in the glomerular capillaries that reduces the amount of filtration C) neutral change in osmotic pressure with no effect on filtration D) increased osmotic pressure in the filtrate the draws plasma through the membrane
b
Match the following: A) Blood supply that directly receives substances from the tubular cells. B) Site of filtrate formation. C) Site that drains the distal convoluted tubule. D) Site at which most of the tubular reabsorption occurs 18) Glomerulus.
b
Match the following: A) Glomerular capillaries B) Vasa recta C) Afferent arterioles D) Peritubular capillaries E) Efferent arterioles 24) Play a role in urine concentration.
b
10) If the diameter of the afferent arterioles leading to the glomerulus decreases (vasoconstriction) which of the following is not likely to occur? A) Glomerular filtration rate will decrease. B) Urine output will decrease. C) Systemic blood pressure will decrease. D) Net filtration pressure will decrease.
c
16) Bulk flow of nutrients, ions and water into the peritubular capillaries is the result of all of the following except one. Select the answer below that does not describe a cause of bulk flow of fluids into the peritubular capillaries. A) higher osmotic pressure in the peritubular capillary B) increased resistance to blood flow at the efferent arteriole C) leaky tight junctions of peritubular capillary's endothelium D) lower hydrostatic pressure in the peritubular capillary
c
17) The mechanism that establishes the medullary osmotic gradient depends most on the permeability properties of the ________. A) collecting duct B) glomerular filtration membrane C) nephron loop D) distal convoluted tubule
c
23) The ________ artery lies on the boundary between the cortex and medulla of the kidney. A) interlobar B) cortical radiate C) arcuate D) lobar
c
24) The descending limb of the nephron loop ________. A) is not permeable to water B) is freely permeable to sodium and urea C) contains fluid that becomes more concentrated as it moves down into the medulla D) pulls water by osmosis into the lumen of the tubule
c
30) Which of the following acts as the trigger for the initiation of micturition (voiding)? A) the pressure of the fluid in the bladder B) motor neurons C) the stretching of the bladder wall D) the sympathetic efferents
c
32) The mechanism of water reabsorption by the renal tubules is ________. A) filtration B) active transport C) osmosis D) cotransport with sodium ions
c
35) Which of the following is not reabsorbed by the proximal convoluted tubule? A) K+ B) Na+ C) creatinine D) glucose
c
38) The function of angiotensin II is to ________. A) decrease the production of aldosterone B) decrease water absorption C) constrict arterioles and increase blood pressure D) decrease arterial blood pressure
c
43) Which of the following is not a part of the juxtaglomerular complex? A) macula densa B) granular cells C) podocyte cells D) mesangial cells
c
46) Which of the following is the correct sequence of kidney development from embryo to fetus? A) mesonephros, metanephros, pronephros B) pronephros, metanephros, mesonephros C) pronephros, mesonephros, metanephros D) mesonephros, pronephros, metanephros
c
57) Which of the hormones below is responsible for facultative water reabsorption? A) thyroxine B) atrial natriuretic peptide C) ADH D) aldosterone
c
8) If the diameter of the afferent arterioles leading to the glomerulus increases (vasodilation) which of the following is not likely to occur? A) Net filtration pressure will increase. B) Urine output will increase. C) Systemic blood pressure will go up. D) Glomerular filtration rate will increase.
c
9) If the diameter of the efferent arterioles leading away from the glomerulus increases (vasodilation) which of the following is not likely to occur? A) Urine output will decrease. B) Net filtration pressure will decrease. C) Systemic blood pressure will decrease. D) Glomerular filtration rate will decrease.
c
Match the following: A) Blood supply that directly receives substances from the tubular cells. B) Site of filtrate formation. C) Site that drains the distal convoluted tubule. D) Site at which most of the tubular reabsorption occurs 20) Collecting duct.
c
Match the following: A) Glomerular capillaries B) Vasa recta C) Afferent arterioles D) Peritubular capillaries E) Efferent arterioles 22) High pressure vessel that forces fluid and solutes into the glomerular capsule.
c
13) If blood pressure drops very low (MAP is below 80mmHg) renin enzyme will be secreted by granular cells. Which of the following is not likely to occur? A) Blood plasma and extracellular fluids volume will increase B) Glomerular filtration rate (GFR) will decrease C) Net filtration pressure (NFP) will decrease D) Kidney perfusion will increase
d
18) Which of the following is not associated with the renal corpuscle? A) a fenestrated capillary B) a podocyte C) an efferent arteriole D) a vasa recta
d
21) The kidneys are stimulated to produce renin ________. A) when the pH of the urine decreases B) when the specific gravity of urine rises above 1.10 C) when the peritubular capillaries are dilated D) by a decrease in the blood pressure
d
22) Which of the choices below is not a function of the urinary system? A) helps maintain homeostasis by controlling the composition, volume, and pressure of blood B) maintains blood osmolarity C) regulates blood glucose levels and produces hormones D) eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat
d
3) The thin segment of the nephron loop's descending limb ________. A) helps to pack a greater number of nephron loops into a smaller space B) aids in the passive excretion of nitrogenous waste C) is easily broken and replaced often D) aids in the passive movement of water out of the tubule
d
34) The macula densa cells respond to ________. A) changes in pressure in the tubule B) aldosterone C) antidiuretic hormone D) changes in Na+ content of the filtrate
d
36) The fluid in glomerular capsule is similar to plasma except that it does not contain a significant amount of ________. A) electrolytes B) hormones C) glucose D) plasma protein
d
39) An important characteristic of urine is its specific gravity or density, which is ________. A) less than water B) much higher than water C) the same as water D) slightly higher than water
d
4) The relatively long half-life of lipid soluble hormones (steroid hormones) compared to water soluble hormones is due in part to the way that these hormones are passed into the filtrate from the glomerular capillaries. From the list below select the best explanation for why lipid soluble (steroid) hormones have a relatively long half-life. A) The large size of the steroid hormones prevents them from passing through the filtration membrane. B) Steroid hormones are absorbed by target cells before they can reach the kidneys. C) The relatively small size of steroid hormones allows them to easily pass back into the peritubular capillaries if released into the filtrate. D) Steroid hormones travel in the plasma on large transport proteins that cannon pass through the filtration membrane.
d
52) Which of the choices below is not a method by which the cells of the renal tubules can raise blood pH? A) by producing new bicarbonate ions B) by reabsorbing filtered bicarbonate ions C) by secreting hydrogen ions into the filtrate D) by secreting sodium ions
d
54) Select the correct statement about urinary system development. A) The metanephric ducts will become the urethras. B) The pronephros (first tubule system) develops during the tenth week of gestation. C) The mesonephros will develop into the kidneys. D) Kidneys develop from urogenital ridges.
d
56) Which of the choices below is the salt level-monitoring part of the nephron? A) nephron loop B) vasa recta C) principal cell D) macula densa
d
59) Which of the choices below are the most important hormone regulators of electrolyte reabsorption and secretion? A) angiotensin I and epinephrine B) angiotensin I and atrial natriuretic peptide C) angiotensin II and ADH D) angiotensin II and aldosterone
d
Match the following: A) Blood supply that directly receives substances from the tubular cells. B) Site of filtrate formation. C) Site that drains the distal convoluted tubule. D) Site at which most of the tubular reabsorption occurs 17) Proximal convoluted tubule.
d
Match the following: A) Glomerular capillaries B) Vasa recta C) Afferent arterioles D) Peritubular capillaries E) Efferent arterioles 21) Low pressure, porous vessels that reabsorb solutes and water from the tubule cells.
d
Match the following: A) Glomerular capillaries B) Vasa recta C) Afferent arterioles D) Peritubular capillaries E) Efferent arterioles 23) May form meandering vessels or bundles of long straight vessels.
e
4) The ________ mechanism is the general tendency of vascular smooth muscle to contract when stretched.
myogenic
2) The need to get up in the middle of the night to urinate is called ________.
nocturia
6) Sodium-linked water flow across a membrane not under hormonal control is called ________ water reabsorption.
obligatory
10) In the absence of hormones, the distal tubule and collecting ducts are relatively impermeable to water.
t
12) The urethra contains an internal sphincter of smooth muscle.
t
14) Aldosterone is a hormone that causes the renal tubules to reclaim sodium ions from the filtrate.
t
18) Incontinence is the inability to control voluntary micturition.
t
2) In the kidneys, the countercurrent mechanism involves the interaction between the flow of filtrate through the nephron loop of the juxtamedullary nephrons (the countercurrent multiplier) and the flow of blood through the limbs of adjacent blood vessels (the countercurrent exchanger). This relationship establishes and maintains an osmotic gradient extending from the cortex through the depths of the medulla that allows the kidneys to vary urine concentration dramatically.
t
21) Tubular secretion is effective in controlling blood pH.
t
23) Atrial natriuretic peptide inhibits sodium reabsorption.
t
25) Blood in the urine may be a symptom of bladder cancer.
t
26) Obligatory water reabsorption involves the movement of water along an osmotic gradient.
t
4) Water reabsorption through the proximal convoluted tubule is termed obligatory water reabsorption, whereas water reabsorption through the distal convoluted tubule is termed facultative water reabsorption.
t
5) The position of the kidneys behind the peritoneal lining of the abdominal cavity is described by the term retroperitoneal.
t
6) The entire responsibility for urine formation lies with the nephron.
t