Patho EXAM #3

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

a. urinary retention and reflux.

A patient is diagnosed with aplastic anemia. The nurse expects to find what patient symptoms upon assessment? (Select all that apply.) a. Lethargy b. Heart palpitations c. Transient murmurs d. Bradycardia e. Orthopnea

a, b, c

Regarding iron-deficiency anemia, what laboratory features are typically decreased? (Select all that apply.) a. MCV b. MCH c. MCHC d. WBC e. Thrombocytes

a, b, c

One of the cardinal features of sickle cell anemia includes acute and chronic dysfunction of which organs? (Select all that apply.) a. Spleen b. Bones c. Brain d. Lungs e. Stomach

a, b, c, d

The nurse is educating a patient diagnosed with anemia of chronic renal failure about the disease. Which statements made by the nurse are correct regarding the patient's treatment? (Select all that apply.) a. "Since your glomerular filtration is 13 mL/min, you'll be started on dialysis." b. "Your hematocrit is 29%, so you're going to start on erythropoietin therapy." c. "Your hemoglobin is 9 g/dL, so you'll need erythropoietin therapy." d. "We need to get your hemoglobin up to at least 15 g/dL" e. "You're going to need iron, folate, and B12 therapy to help improve your blood counts."

a, b, c, e Therapy for anemia of chronic renal failure consists of dialysis when the glomerular filtration rate is less than 15 mL/min, and erythropoietin is administered to achieve the target hematocrit of 33% to 36% and hemoglobin of 11 to 12 g/dL. Patient replacement of iron, folate, and B12 to adequate levels is also recommended. Using erythropoiesis-stimulating agents to increase hemoglobin values to greater than 12 g/dL is not routinely recommended.

The blood urea nitrogen (BUN) level is affected by (Select all that apply.) a. protein intake. b. fat intake. c. fluid intake. d. catabolism. e. renal function.

a, c, d, e

Hormones that increase sodium reabsorption from the tubular fluid include (Select all that apply.) a. aldosterone. b. atrial natriuretic peptide. c. antidiuretic hormone. d. urodilatin. e. angiotensin II.

a, e

A person with acute pyelonephritis would most typically experience a. fever. b. oliguria. c. edema. d. hypertension.

a. fever

Factors that increase the glomerular filtration rate include a. fluid volume excess. b. increased hydrostatic pressure in the Bowman's capsule. c. high oncotic pressure in glomerular capillary blood. d. obstruction in the renal tubules.

a. fluid volume excess.

The primary selectivity barrier for glomerular filtration is the a. glomerular basement membrane. b. endothelial tight junctions. c. epithelial fenestra. d. mesangial cells.

a. glomerular basement membrane

Red blood cells obtain nearly all their energy from metabolism of a. glucose. b. fats. c. proteins. d. acetyl coenzyme A.

a. glucose For RBCs to survive and perform efficiently, they must have a source of energy. Essential for red blood cell viability is the glucose that is used for metabolism. RBC membrane structures are formed from double layer of phospholipids. Fats do not provide energy to red blood cells. A protein network on the surface of the membrane is important for cell structure, but does not provide energy for red blood cell production and maintenance. Acetyl coenzyme A is not a factor in providing energy to the red blood cells.

Hyperlipidemia occurs in nephrotic syndrome because a. hepatocytes synthesize excessive lipids. b. lipids are not excreted in the urine. c. body fats are catabolized. d. muscles stop burning triglycerides for energy.

a. hepatocytes synthesize excessive lipids.

The most common sign/symptom of renal calculi is a. pain. b. vomiting. c. hematuria. d. oliguria.

a. pain

An important sign of glomerular basement membrane dysfunction is a. proteinuria. b. hematuria. c. glycosuria. d. urinary casts.

a. proteinuria.

Anemia related to vitamin B12 or folate deficiency is characterized by what laboratory features? (Select all that apply.) a. RBC counts of 775,000 to 900,000 cells/mm3 b. RBC counts of 500,000 to 750,000 cells/mm3 c. WBC counts of 3000 to 4000 cells/mm3 d. WBC counts of 4000 to 5000 cells/mm3 e. Platelet counts of 60,000 cells/mm3

b, d

The organism most commonly associated with acute pyelonephritis is a. Streptococcus. b. Escherichia coli. c. Klebsiella. d. Enterobacter.

b. Escherichia coli.

Most carbon dioxide is transported in the bloodstream as a. carboxyhemoglobin. b. bicarbonate ion. c. dissolved carbon dioxide. d. carbonic acid.

b. bicarbonate ion

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

b. calcium

A major modifiable risk factor for nephrolithiasis is a. positive family history. b. dehydration. c. smoking. d. drinking alcohol..

b. dehydration

Red blood cells differ from other cell types in the body, because they a. contain cytoplasmic proteins. b. have no cytoplasmic organelles. c. have a longer life span. d. contain glycolytic enzymes.

b. have no cytoplasmic organelles Red blood cells have no cytoplasmic organelles, nucleus, mitochondria, or ribosomes. Therefore, RBCs cannot synthesize protein or carry out oxidative reactions. Red blood cells are not capable of synthesizing protein because of their lack of organelles. Red blood cells live for 80 to 120 days in the circulation and then die and are replaced. Red blood cells do not contain glycolytic enzymes.

The main driving force for glomerular filtration is a. oncotic pressure in the Bowman's capsule. b. hydrostatic pressure in glomerular capillaries. c. permeability of the glomerular membrane. d. solute content of the blood in the glomerular capillaries.

b. hydrostatic pressure in glomerular capillaries.

The major cause of glomerulonephritis is a. infection of the glomerular capsule secondary to a urinary tract infection. b. immune system damage to the glomeruli. c. hydronephrosis resulting from kidney stones. d. Streptococcus infection that migrates from the bloodstream to the glomerulus.

b. immune system damage to the glomeruli

Pernicious anemia is caused by a lack of a. iron. b. intrinsic factor. c. folate. d. erythropoietin.

b. intrinsic factor.

What is necessary for red blood cell production? a. Phosphate b. Iron c. Magnesium d. Calcium

b. iron Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.

The cause of the most common form of anemia is a. acute bleeding. b. iron deficiency. c. protein malnutrition. d. chronic disease.

b. iron deficiency

The primary source of erythropoietin is provided by the a. bone marrow. b. kidney. c. lung. d. liver.

b. kidney Erythropoietin is a hormone that is secreted into the bloodstream by the kidney. Bone marrow is not responsible for the production of erythropoietin. Hypoxia from low hemoglobin levels causes a decrease in tissue oxygen tension in the kidney, thereby releasing the hormone erythropoietin. The liver is not associated with erythropoietin production.

The most appropriate treatment for secondary polycythemia is a. volume expansion with saline. b. measured to improve oxygenation. c. phlebotomy. d. chemotherapy.

b. measured to improve oxygenation.

Thalassemia may be confused with iron-deficiency anemia, because they are both a. hyperchromic. b. microcytic. c. genetic. d. responsive to iron therapy.

b. microcytic

The pain that accompanies kidney disorders is called a. nephritic. b. nephralgia. c. nephrotic. d. nephronitis.

b. nephralgia

It is true that glucose reabsorption in the tubules a. occurs passively. b. occurs in the proximal convoluted tubule. c. is unlimited. d. simply does not occur.

b. occurs in the proximal convoluted tubule

The strength of the bond between oxygen and hemoglobin is known as the a. Bohr effect. b. oxygen-hemoglobin affinity. c. dissociation curve. d. hemoglobin synthesis.

b. oxygen-hemoglobin affinity The strength of the bond between oxygen and hemoglobin is called the oxygen-hemoglobin affinity. Hemoglobin saturation is higher when oxygen infinity is increased, and saturation is lower when affinity is decreased. The Bohr effect occurs when the oxyhemoglobin dissociation curve experiences a shift resulting from changes in PCO2 and H+ concentration. The dissociation curve describes the relationship between the partial pressure of oxygen and hemoglobin saturation. Hemoglobin synthesis occurs in the immature red cell.

Signs consistent with a diagnosis of glomerulonephritis include a. anuria. b. proteinuria. c. red blood cell casts in the urine. d. foul-smelling urine.

b. proteinuria

Excessive red cell lysis can be detected by measuring the serum a. hemoglobin. b. methemoglobin. c. bilirubin. d. erythropoietin.

c. bilirubin.

The most effective therapy for anemia associated with kidney failure is a. iron administration. b. high-protein diet. c. erythropoietin administration. d. vitamin B12 and folate administration.

c. erythropoietin administration

Findings that should prompt an evaluation for renal cancer include a. bacteria in the urine. b. intermittent urinary colic. c. hematuria. d. red blood cell casts in the urine.

c. hematuria

Nephrotic syndrome does not usually cause a. hyperlipidemia. b. proteinuria. c. hematuria. d. generalized edema.

c. hematuria

A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia? a. Vitamin B12 deficiency b. Folate deficiency c. Iron deficiency d. Erythropoietin deficiency

c. iron deficiency Iron-deficiency anemia is characterized by a low hemoglobin concentration and low mean corpuscular volume. Vitamin B12 deficiency anemia is characterized by a high concentration of MCV and a normal level of MCHC. Folate deficiency anemia is characterized by a normal mean corpuscular hemoglobin concentration and a high mean corpuscular volume. Erythropoietin deficiency creates hypoxia from a low hemoglobin level.

Renin is released from a. the posterior pituitary gland. b. the liver. c. juxtaglomerular cells. d. macula densa cells.

c. juxtaglomerular cells

Serum creatinine may be increased by a. carbohydrate intake. b. fat intake. c. muscle breakdown. d. fluid intake.

c. muscle breakdown.

The primary function of the vasa recta is to a. secrete renin. b. reabsorb NaCl. c. reabsorb interstitial fluid. d. secrete urea.

c. reabsorb interstitial fluid

Excess potassium is excreted from the body by the renal system primarily via a. glomerular filtration based on blood level of potassium. b. reabsorption based on blood level of potassium. c. secretion based on aldosterone level. d. an unknown mechanism.

c. secretion based on aldosterone level.

Serious renal impairment generally does not occur until ____ of the total nephrons have been damaged. a. 20% b. 40% c. 60% d. 80%

d. 80%

What laboratory finding is usually found in aplastic anemia? a. Leukocytosis b. Thrombocythemia c. Neutrophilia d. Pancytopenia

d. Pancytopenia

Which finding on urinalysis should prompt further evaluation? a. pH 4.5 b. Red blood cells 2 per high-power field c. Specific gravity of 1.015 d. White blood cells 20 per high-power field

d. White blood cells 20 per high-power field

The pathophysiologic basis of acute glomerulonephritis is a. renal ischemia. b. bacterial invasion of the glomerulus. c. an anaphylactic reaction. d. an immune complex reaction.

d. an immune complex reaction.

It is true that polycystic kidney disease is a. always rapidly fatal. b. caused by a streptococcal infection. c. associated with supernumerary kidney. d. genetically transmitted.

d. genetically transmitted.

Patients who experience anemic episodes when exposed to certain drugs most likely have a. thalassemia. b. spherocytosis. c. sickle cell anemia. d. glucose-6-phosphate dehydrogenase deficiency.

d. glucose-6-phosphate dehydrogenase deficiency.

The most common direct cause of acute pyelonephritis is a. urine obstruction. b. systemic bacteremia. c. urethral catheterization. d. infection by E. coli.

d. infection by E. coli.

Which characteristic is indicative of hemolytic anemia? a. Increased total iron-binding capacity b. Increased heart rate c. Hypovolemia d. Jaundice

d. jaundice Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated with an increased heart rate unless there is aplastic crisis associated with infection. Hypovolemia is not an indication of hemolytic anemia.

The glucose transporter in the proximal tubule a. has no transport maximum. b. does not depend on sodium reabsorption. c. is ATP-dependent. d. may be saturated at high filtered glucose loads.

d. may be saturated at high filtered glucose loads

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

d. nephrotic syndrome.

Nephrotic syndrome involves loss of large amounts of ________ in the urine. a. blood b. sodium c. glucose d. protein

d. protein

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

d. proteinuria

Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed by the a. loop of Henle. b. collecting tubule. c. distal tubule. d. proximal tubule.

d. proximal tubule

The glomerular filtration rate is most accurately reflected in the a. blood urea nitrogen level. b. urinary output. c. serum osmolality. d. serum creatinine level.

d. serum creatinine level.

An increase in hemoglobin affinity for oxygen occurs with a. hyperthermia. b. shift to the right. c. elevated PCO2 d. shift to the left.

d. shift to the left An increase in oxygen affinity is known as a shift to the left on the dissociation curve. Hyperthermia does not have an effect on the hemoglobin affinity. Elevation in PCO2 is seen with changes in pH. A decrease in the oxygen affinity is associated with a shift to the right on the oxyhemoglobin dissociation curve.

A patient with gouty arthritis develops renal calculi. The composition of these calculi is most likely to be a. potassium oxalate. b. struvite. c. cysteine. d. uric acid crystals.

d. uric acid crystals