Patho 370 - CYU Week 5

Uterine prolapse is caused by a relaxation of the a. cardinal ligaments. b. vaginal musculature. c. cervix. d. abdominal organs.

A Alterations in uterine position and pelvic support may occur anytime during a woman's reproductive years. The major support for the uterus and upper part of the vagina is provided by the thickenings of the endopelvic fascia known as the cardinal ligaments . If the support of the vaginal wall is also compromised, the pressure of the abdominal organs on the uterus will gradually force it downward through the vagina into the introitus. The relaxation of the cardinal ligaments permits the cervix to sag into the vagina. Uterine prolapse can occur when the supporting structures and the cardinal ligaments relax and allow the uterus to sag into the vagina.

The most common types of uterine tumors are known as a. leiomyomas. b. ovarian cysts. c. endometriomas. d. hydatidiform moles.

A Benign fibroid tumors, or leiomyomas, are the most common uterine tumor, affecting about 20% of women older than 35 years. Ovarian cysts are sacs on an ovary that contain fluid or semisolid material. Endometriomas, or endometrial implants, usually occur in the pelvis. Theca-lutein cysts are commonly bilateral and filled with clear, straw-colored fluid. Often their development is associated with hydatidiform moles.

Postrenal acute kidney injury may be caused by a. bilateral kidney stones. b. glomerulonephritis. c. acute tubular necrosis. d. severe hypotension.

A Bilateral kidney stones can cause postrenal acute kidney injury as a result of obstruction of normal outflow of urine from the kidneys. Severe hypotension causes prerenal acute kidney injury. Glomerulonephritis does not cause postrenal acute kidney injury, because the glomeruli are located within the kidneys. Acute tubular necrosis does not cause postrenal acute kidney injury, because the renal tubules are located within the kidneys.

Appropriate management of end-stage renal disease includes a. erythropoietin administration. b. potassium supplementation. c. a high-protein diet. d. a high-phosphate diet.

A Erythropoietin administration is appropriate, as the kidneys are not able to secrete erythropoietin. Potassium is not appropriate, as the kidneys are unable to excrete potassium. A high-protein diet is not appropriate, as the kidneys are unable to excrete urea. A high-phosphate diet is not appropriate, as the kidneys are unable to excrete phosphorous.

Calcium oxylate stone formation is facilitated by a. hypercalciuria. b. hypoparathyroidism. c. low urine pH. d. protein intake.

A Hypercalciuria facilitates calcium oxylate stone formation. Hyperparathyroidism and high urine pH facilitate calcium stone formation. Protein intake does not facilitate calcium stone formation.

Excessive vomiting in pregnant women is known as a. hyperemesis gravidarum. b. placenta previa. c. abruptio placentae. d. spontaneous abortion.

A Hyperemesis gravidarum is a Latin term for excess of vomiting in pregnant women. Although transient nausea and vomiting occur in about half of women in the first trimester of pregnancy, in a few women these symptoms continue throughout the entire course of pregnancy. Placenta previa is a condition in which the placenta is implanted abnormally over the internal cervical os. Abruptio placentae is premature separation of the placenta before delivery of the fetus. Spontaneous abortion is expulsion of the products of conception from the uterus before the period of fetal viability.

A potential risk factor for breast cancer includes a. early menarche and late first pregnancy. b. malnourishment. c. a history of fibrocystic breast disease. d. more than three pregnancies prior to age 35.

A It has been observed in many research studies that giving birth at a young age (less than 18 years) is associated with a decreased risk of breast cancer, and that giving birth for the first time aged 35 years or older increases the risk. Recent research has disproved the theory that fibrocystic breast disease leads to cancer. Parity (the number of children a woman has given birth to) has been associated with risk, with low parity increasing risk and high parity having a protective effect. It has been suggested that the amount of fat in the diet is a risk factor for breast cancer.

A breast lump that is painless, hard, and unmoving is most likely a. carcinoma. b. papilloma. c. fibroadenoma. d. fibrocystic breast disease.

A Malignant tumors are usually painless, hard, and poorly movable. Masses in fibrocystic breast disease are firm, mobile, and tender. Fibroadenomas are a benign breast disorder. Papillomas are a specific benign neoplasm of the breast.

When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of protein," the nurse's response is based on the knowledge that a. the glomerular membrane has increased permeability. b. his liver is extremely active in synthesizing protein. c. his glomeruli have been damaged by his own immune system. d. his renal tubules are full of cellular debris.

A Massive proteinuria occurs in nephrotic syndrome because the glomerular membrane has increased permeability that causes the leakage of protein. Glomeruli being damaged by the immune system and cellular debris in the renal tubules are not pathophysiologies of the nephrotic syndrome. Although the liver is extremely active in synthesizing protein, it does not explain why massive proteinuria occurs in nephrotic syndrome.

Phimosis is a disorder of the penis characterized by a. inability to retract the foreskin. b. sustained, painful erection. c. malpositioning of the urinary meatus. d. inability to achieve erection.

A Phimosis is a disorder of the foreskin, associated with chronic inflammation, and results in a foreskin that cannot be retracted. A sustained, painful erection is known as priapism. Impotence is the inability to achieve an erection. Malpositioning of the urinary meatus (hypospadias) is a congenital anomaly, while phimosis is an acquired anomaly.

Vesicoureteral reflux is associated with a. recurrent cystitis. b. proteinuria. c. polycystic renal disease. d. increased serum creatinine.

A Recurrent cystitis is associated with vesicoureteral reflux. Increased serum creatinine, polycystic renal disease, and proteinuria are not associated with vesicoureteral reflux.

The oliguric phase of acute tubular necrosis is characterized by a. fluid excess and electrolyte imbalance. b. fever and diminishing cognition. c. magnesium and phosphorous loss in the urine. d. sodium retention and potassium loss in the urine.

A The oliguric phase of ATN is characterized by fluid excess and electrolyte imbalance. Fever and diminishing cognition are not typical manifestations of ATN oliguric phase. During this phase sodium is lost in the urine and potassium is not excreted, and magnesium and phosphorous are retained in the body.

Glomerular disorders include a. nephrotic syndrome. b. interstitial cystitis. c. obstructive uropathy. d. pyelonephritis.

A The pathophysiology of nephrotic syndrome occurs at the glomerular membrane. Pyelonephritis generally does not affect the glomerulus. Obstructive uropathy affects the upper and lower urinary tract but does not directly involve the glomerulus. Interstitial cystitis is a bladder disorder.

Treatment of a uterine prolapse may involve the insertion of a(n) ________ to hold the uterus in place. a. pessary. b. endopelvic mesh implant. c. IUD. d. catheter.

A Uterine prolapse is one of the most common reasons for hysterectomy usually from the vaginal approach. In patients who are at poor risk for surgery or who choose not to have a hysterectomy, a pessary, which is a small supportive device, is inserted to hold the uterus in place. A urinary catheter is not useful in holding the uterus in place. An intrauterine device would not be useful in treating a uterine prolapse. Uterine prolapse is not treated with insertion of a mesh implant.

One of the most frequent causes of chronic kidney disease is a. glomerulonephritis. b. hypertension. c. chronic pyelonephritis. d. polycystic kidney disease.

B Hypertension and diabetes are the most common causes of chronic kidney disease. Although glomerulonephritis, chronic pyelonephritis, and polycystic kidney disease can result in CKD, hypertension and diabetes are the most common causes of chronic kidney disease.

The condition in which the urethra opens on the dorsal aspect of the penis is known as a. hypospadias. b. epispadias. c. priapism. d. urethral fistula.

B In epispadias , the urethra opens on the dorsal aspect of the penis at a point proximal to the glans. In hypospadias, the urethral meatus is located on the ventral undersurface of the penis or on the perineum. A urethral fistula is a failure of the urorectal septum to develop completely. Priapism is defined as a painful, persistent erection.

Pelvic floor muscle training is appropriate for a. reflux prevention. b. functional incontinence. c. urge incontinence. d. overflow incontinence.

C Pelvic floor muscle training is appropriate for urge incontinence. These exercises will help strengthen the pelvic muscles so the patient is able to hold urine in the bladder longer. Pelvic floor muscle training is not appropriate for overflow incontinence, reflux prevention, or functional incontinence.

The patient reports persistent pelvic pain and urinary frequency and urgency. She says the pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are characteristic of a. neurogenic bladder. b. interstitial cystitis. c. ureteral stone. d. neuroses.

B Interstitial cystitis results in urgency, frequency, and pelvic pain that is relieved when the bladder is emptied. It is associated with other pain syndromes such as fibromyalgia. This condition can be caused by damage to the bladder wall from inflammation, as with her history of recurrent bladder infections. A physiologic basis for this condition exists and it is not a result of psychological neuroses. These symptoms are not consistent with a ureteral stone. This patient has no indications of neurogenic bladder.

Osteoporosis commonly occurs in patients with end-stage renal disease because of a. phosphorous deficiency. b. hyperparathyroidism. c. hypercalcemia. d. excess active vitamin D.

B Osteoporosis commonly occurs in patients with end-stage renal disease because of hyperparathyroidism. Hypocalcemia occurs in end-stage renal disease. Insufficient active vitamin D would result in osteoporosis. Phosphate is retained in end-stage renal disease.

The most frequent initial symptom of bladder cancer is a. sudden incontinence. b. hematuria. c. bladder infection. d. dysuria.

B Painless hematuria is usually the initial symptom of bladder cancer. Although bladder infection may occur with bladder cancer, this is not the most frequent initial symptom. Sudden incontinence is not associated with bladder cancer. Dysuria can occur with bladder cancer, but it is rare.

The majority of penile cancer cases are classified as basal cell carcinoma. a. True b. False

B The majority of penile cancer cases are classified as squamous cell carcinoma.

The most common cause of urinary obstruction in male newborns and infants is urethral valves. a. False b. True

B The most common cause of urinary obstruction in male newborns and infants is urethral valves.

The most commonly ordered diagnostic test for evaluation of the urinary system is a. cystogram. b. ultrasonography. c. cystography. d. KUB.

B The most commonly ordered diagnostic test for evaluation of the urinary system is ultrasonography because it provides excellent visualization of the urinary tract without the use of radiation or contrast media, and it is painless. KUB, cystogram, and cystography are not the most frequently ordered tests.

The direct cause of stress incontinence is a. neurologic conditions. b. pelvic muscle weakness. c. the effect of aging. d. detrusor muscle overactivity

B The primary cause of stress incontinence is loss of pelvic muscles and/or fascial support of the bladder and urethra. Although aging weakens the pelvic muscles, it is not the direct cause of stress incontinence. Neurologic conditions cause neurogenic bladder which can lead to incontinence, but this is not the same as stress incontinence. Overactivity of the detrusor muscle leads to urge incontinence.

Dysfunctional uterine bleeding (DUB) is caused by a. reproductive tract malignancies. b. absent or diminished levels of progesterone. c. endometrial fibroid tumors. d. endometrial inflammation.

B The term dysfunctional uterine bleeding is used to describe abnormal endometrial bleeding not associated with tumor, inflammation, pregnancy, trauma, or hormonal effects. Absent or diminished levels of progesterone will result in a thick and extremely vascular endometrium that lacks structural support. As a result of this fragile structure, spontaneous and superficial hemorrhage occurs randomly throughout the endometrium. Dysfunctional uterine bleeding is used to describe abnormal endometrial bleeding not associated with inflammation. DUB is used to describe abnormal bleeding not associated with tumors or malignancies. Fibroid tumors are not associated with the term dysfunctional uterine bleeding.

In addition to E. coli, a risk factor for development of pyelonephritis is a. respiratory disease. b. urinary retention and reflux. c. nephrotic syndrome. d. glomerulonephritis.

B When E. coli is present, urinary retention and reflux increase the risk of the infection ascending the ureter to the kidneys, causing pyelonephritis. Nephrotic syndrome, respiratory disease, and glomerulonephritis are not risk factors for pyelonephritis.

The risk for contrast media-induced acute tubular necrosis (ATN) is highest in a. a 50-year-old patient post gallbladder surgery. b. a 12-year-old patient with recurrent bladder infections. c. a 30-year-old patient with appendicitis. d. a 70-year-old patient with heart failure.

D This patient with the highest risk has two risk factors for contrast media-induced ATN: age over 70 and co-existing heart failure. The other patients have no risk factors for contrast media-induced ATN.

Which intervention has been found to retard the advancement of chronic kidney disease? a. Erythropoietin b. Calcium supplementation c. ACE inhibitors d. Insulin

C ACE inhibitors or A-II receptor blockers have been found to retard the advancement of chronic kidney disease by reducing proteinuria. Calcium supplementation, erythropoietin, and insulin have not been found to retard the advancement of chronic kidney disease.

The individual at highest risk of pyelonephritis who requires monitoring for signs of its occurrence is the a. woman who is paraplegic. b. woman who is pregnant. c. man who has chronic urinary tract infections. d. man who has glomerulonephritis.

C Anyone who has chronic urinary tract infections is at high risk of developing pyelonephritis. Although pregnancy and stasis of urine with paraplegia do increase the risk of pyelonephritis, another individual has an even higher risk because of an active urinary tract infection. Glomerulonephritis is not an infection.

A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because a. malnutrition is part of nephrotic syndrome. b. hepatocyte failure decreases albumin synthesis. c. albumin is excreted in the urine. d. albumin leaks into the interstitial spaces.

C Hypoalbuminemia in nephrotic syndrome is caused by massive albumin excretion in the urine. Hepatocyte failure, malnutrition, and albumin leakage into the interstitial spaces are not characteristic of nephrotic syndrome.

Renal insufficiency occurs when _____ of the nephrons are not functional. a. 50% b. more than 90% c. 75% to 90% d. 25%

C In renal insufficiency, 75% to 90% of the nephrons are not functional. When 25% to 50% of nephrons are not functional, it is decreased renal reserve. When 90% of nephrons are not functional, it is end-stage renal disease.

The expected treatment of a pregnant woman with hyperemesis gravidarum is a. immediate cesarean section. b. surgical removal of uterine contents. c. intravenous therapy. d. seizure prophylaxis.

C Intravenous therapy to correct metabolic and nutritional abnormalities, antiemetic agents, and supportive care in a hospital environment may be needed to resolve the symptoms of hyperemesis gravidarum. Therapeutic strategies for placenta previa and abruptio placentae include cesarean section for fetal distress or hemorrhage control. Seizure prophylaxis may be indicated in the presence of pregnancy-induced hypertension. If an incomplete abortion has occurred, it may be necessary to surgically remove the remaining uterine contents

A progressive decrease in the force of the urinary stream, dribbling of urine, and difficulty initiating the urinary stream are characteristic of a. urinary calculi. b. prostatitis. c. bladder carcinoma. d. prostatic enlargement.

D A decrease in the force of the urinary stream, hesitancy or difficulty in initiating a urinary stream, and interruption of the stream may occur with prostatic enlargement. Prostatitis presents with frequency, urgency, and dysuria. Urinary calculi cause sudden, severe onset of pain. Bladder carcinoma is usually characterized by hematuria, painful or frequent urination, and abdominal or back pain.

A 52-year-old female had a surgical procedure in which the breast, lymphatics, and underlying muscle were removed. The procedure performed was a a. modified radical mastectomy. b. mastectomy. c. lumpectomy. d. radical mastectomy

D A radical mastectomy is a rare procedure in which the breast, lymphatic drainage, and underlying pectoral muscles are removed. A modified radical mastectomy occurs when the breast is removed and a portion of the axillary lymphatic system is dissected. Removal of the breast only is a simple mastectomy. A lumpectomy is the removal of the lesion only.

Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing a. renal inflammation. b. nephrosis. c. hydronephrosis. d. acute tubular necrosis.

D Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage may all contribute to renal failure by causing acute tubular necrosis. Gastrointestinal drainage, perioperative and postoperative hypotension, and hemorrhage do not cause hydronephrosis, nephrosis, or renal inflammation.

The major underlying factor leading to the edema associated with glomerulonephritis and nephrotic syndrome is a. glycosuria. b. hematuria. c. bacteriuria. d. proteinuria.

D Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis. Hematuria and bacteriuria are not the major factors underlying the edema associated with nephrotic syndrome and glomerulonephritis. Proteinuria is the major factor underlying the edema associated with nephrotic syndrome and glomerulonephritis.

The urea-splitting bacteria contribute to the formation of ________ kidney stones. a. calcium oxalate b. uric acid c. cystine d. struvite

D Struvite kidney stones are caused by the urea-splitting bacteria. Calcium oxalate, uric acid, and cystine stones are not caused by the urea-splitting bacteria.

A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?", the nurse responds a. "Normally, red blood cells that enter the urine are taken back into the blood, but in glomerulonephritis, the kidney disease you have, they stay in the urine and make it coffee-colored." b. "When parts of your kidneys stopped working, your blood kept flowing and broke some of your little blood vessels, so red blood cells are flowing into your urine and making it coffee-colored." c. "The bacteria that caused your sore throat have traveled to your kidneys and are causing a little damage there that allows some red blood cells to leak into your urine and make it orange-colored." d. "Your immune system was activated by your sore throat and has caused some damage in your kidneys that allows red blood cells to leak into the fluid that becomes urine and make it coffee-colored."

D The immune system damages glomeruli in post-streptococcal glomerulonephritis causing red blood cells to leak into the urine, making it coffee-colored. Red blood cells that enter the urine are not taken back into the blood. Red blood cells cause urine to turn coffee-colored, not orange. Capillary breakage is not the cause of the red blood cells entering the urine.

The most common type of renal stone is a. uric acid. b. cysteine. c. struvite. d. calcium.

D The most common type of renal stone is calcium oxalate (75%). Uric acid stones account for 7% to 10%. Struvite stones account for 7% to 10%. Cysteine stones account for 1% to 3%.

A patient injured severely in a motor vehicle accident is hospitalized with acute kidney injury as well as multiple broken bones and lacerations. When family members ask what is meant by the term 'prerenal,' the nurse responds a. "Acute kidney injury is a new term for what people used to call acute renal failure." b. "Your husband's kidney injury is only the beginning of the problems that are expected, so they are being vigilant." c. "The doctors are not sure what caused your husband's acute kidney injury, but they are working to help him recover." d. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney."

D The problem that triggers prerenal acute kidney injury occurs before the blood circulates to the kidney. Hypovolemia is a common cause of prerenal acute kidney injury. Providing the patient's family with specific information is most effective. Telling the family that you don't know what caused the injury does not alleviate anxiety in the family member. Speculating about the patient's future without a clear prognosis causes anxiety in the patient. It is best to provide the family with specific information regarding the patient's diagnosis and prognosis instead of offering general comments.