Patho quiz 5

A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating a. "His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered." b. "We had better measure his blood sugar. He may have developed diabetes, and what you see is osmotic diuresis from glucose in the urine." c. "Since he was oliguric for so long, he probably has rebound polyuria. As long as his blood pressure is stable, he is not hypovolemic, so I would not worry." d. "I am glad you noticed this change. It happened so gradually that we did not see it. We should call the doctor and get him to measure ADH."

a. "His renal tubules are recovering, so he is making more urine, but he is not able to concentrate urine well, because he is not fully recovered." You have recognized the postoliguric phase of acute tubular necrosis. He does not have rebound polyuria. The polyuria is part of acute tubular necrosis and is not an ADH problem. The polyuria is part of acute tubular necrosis and is not an osmotic diuresis.

Infection by ________ accounts for nearly half of all reported cases of vulvovaginitis. a. Candida albicans b. Chlamydia trachomatis c. Pseudomonas d. Neisseria gonorrhoeae

a. Candida albicans Infection by Candida albicans (formerly called Monilia) accounts for approximately half of all reported cases of vulvovaginitis. Chlamydia trachomatis is a common cause of pelvic inflammatory disease. Neisseria gonorrhoeae is a common causative agent in PID, because it can penetrate the bacteriostatic barrier of cervical mucous. Pseudomonas may be associated with PID.

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

a. Escherichia coli. Escherichia coli is the most common cause of acute pyelonephritis. Streptococcus, Klebsiella, and Enterobacter are not the most common causes of acute pyelonephritis.

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

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

A patient with renal disease is at risk for developing uremia as the nephrons progressively deteriorate, because a. GFR declines. b. the basement membrane becomes increasingly permeable. c. excessive solute and water are lost in the urine. d. filtration exceeds secretory and reabsorptive capacity.

a. GFR declines. A patient with renal disease is at risk for developing uremia as his nephrons progressively deteriorate because GFR declines. The basement membrane does not become increasingly permeable. Filtration does not exceed secretory and reabsorptive capacity. Excessive solute and water are not lost in the urine.

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

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

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

a. a 70-year-old patient with heart failure. 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.

A ureterocele is a. a cystic dilation of a ureter. b. fusion of both ureters at the bladder junction. c. an abnormally placed ureter. d. an additional ureter.

a. a cystic dilation of a ureter. Ureterocele is a cystic dilation of a ureter at its distal end. An abnormally placed ureter is called ureteral ectopy. An additional ureter is called ureteral ectopy. A ureterocele is not a fusion of both ureters at the bladder junction.

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

a. albumin is excreted in the urine. 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.

A patient has ureteral colic. The manifestation that requires immediate notification of the physician is a. chills and fever. b. severe flank pain. c. vomiting. d. pink-tinged urine.

a. chills and fever. Chills and fever are not commonly associated with ureteral colic unless infection exists. This should be reported to the physician. Severe flank pain is common in ureteral colic. Nausea and vomiting are common with ureteral colic resulting from the common dermatomes. Pink-tinged urine is common in ureteral colic, as the stone irritates the ureteral wall and causes minor bleeding.

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

a. early menarche and late first pregnancy. 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 patient diagnosed with a micropenis must be evaluated for a. endocrine disorders. b. female sex assignment. c. vascular abnormalities. d. epispadias.

a. endocrine disorders. Penile development and growth are both testosterone-dependent. Patients with micropenis must be evaluated for endocrine abnormalities. Micropenis has been shown to be related to vascular disorders. Female sex assignment is considered only after treatment failure. Epispadias is an abnormality of the urethral opening and unrelated to micropenis.

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

a. epispadias. 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.

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

a. hematuria. 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.

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

a. hepatocytes synthesize excessive lipids. Hyperlipidemia in nephrotic syndrome is caused by increased hepatic synthesis of lipids. People who have nephrotic syndrome have both hyperlipidemia and lipiduria. Catabolized body fats and muscles not burning triglycerides for energy are not the causes of hyperlipidemia in nephritic syndrome.

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

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

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

a. hyperparathyroidism. 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 likely cause of acidosis in a patient with end-stage renal disease is a. insufficient metabolic acid excretion resulting from nephron loss. b. insufficient filtration of bicarbonate ions at the glomerulus. c. excessive production of respiratory and metabolic acids. d. hypoventilation secondary to uremic central nervous system depression.

a. insufficient metabolic acid excretion resulting from nephron loss. The most likely cause of acidosis in a patient with end-stage renal disease is insufficient metabolic acid excretion resulting from nephron loss. Insufficient filtration of bicarbonate at the glomerulus would lead to alkalosis, not acidosis. Excessive production of respiratory acids would lead to respiratory acidosis not metabolic acidosis. The problem is metabolic acids are not excreted. Hypoventilation secondary to uremic CNS depression may occur, but this would lead to respiratory acidosis, not metabolic acidosis.

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. interstitial cystitis. b. neuroses. c. neurogenic bladder. d. ureteral stone.

a. interstitial cystitis. 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.

The disorder characterized by a neurologic lesion that affects bladder control is a. neurogenic bladder. b. cystitis. c. detrusor inactivity. d. bladder prolapse.

a. neurogenic bladder. Neurogenic bladder is a condition in which neurologic lesions cause bladder dysfunction. Neurologic lesions can be characteristic of detrusor overactivity, not detrusor inactivity. Neurologic lesions are not characteristic of bladder prolapse. Neurologic lesions are not characteristic of cystitis, although stasis of urine as a result of neurologic lesions may increase the risk of cystitis.

The defining characteristic of severe acute kidney injury is a. oliguria. b. hematuria. c. proteinuria. d. diuresis.

a. oliguria. Acute kidney injury is defined by oliguria or anuria. Proteinuria, hematuria, and diuresis are not defining characteristics of severe acute kidney injury.

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

a. ultrasonography. 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.

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. 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.

A patient, age 3, has vesicoureteral reflux. "Why does that make him have so many bladder infections?" asks his mother. The nurse's best response is a. "When he urinates, urine leaks into his bowel and bacteria from the bowel leak into the bladder, where they grow and make a bladder infection." b. "When he urinates, urine runs back toward his kidneys and then into the bladder again, making it easy for bacteria to grow if they reach the bladder." c. "When he urinates, urine stays in his bladder and the normal bacteria that live in the bladder have a chance to grow and cause a bladder infection." d. "When he urinates, the urine makes a fluid trail to the bladder, and if he does not clean himself well, bacteria will enter and make a bladder infection."

b. "When he urinates, urine runs back toward his kidneys and then into the bladder again, making it easy for bacteria to grow if they reach the bladder." Vesicoureteral reflux causes urine to reflux into the ureters during bladder contraction; the urine then falls into the bladder again, making it easy for bacteria to grow if they reach the bladder. A fluid trail to the bladder is not the cause of frequent bladder infections. Vesicoureteral reflux does not cause urine to enter the bowel. Urine that remains in the bladder is not the cause of vesicoureteral reflux.

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

b. pessary. 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.

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. "The doctors are not sure what caused your husband's acute kidney injury, but they are working to help him recover." b. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney." c. "Your husband's kidney injury is only the beginning of the problems that are expected, so they are being vigilant." d. "Acute kidney injury is a new term for what people used to call acute renal failure."

b. "Your husband's kidney injury did not start in the kidney itself, but rather in the blood flow to the kidney." 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.

What reproductive tract disorder is most likely to be associated with urinary stress incontinence? a. Menopause b. Cystocele c. Cervicitis d. Rectocele

b. Cystocele A cystocele is a protrusion of a portion of the urinary bladder into the anterior of the vagina at a weakened part of the vaginal musculature. In moderate to severe cases, a sensation of pressure can be felt in the vagina, along with dysuria, incontinence, and back pain. Clinical manifestations of rectocele would involve difficulties in bowel evacuation or constipation. Urinary stress incontinence is not a manifestation of menopause. Cervicitis is not associated with urinary stress incontinence.

Hypotension is both a cause of chronic kidney disease and a result of chronic kidney disease. a. True b. False

b. False Hypertension is both a cause of chronic kidney disease and a result of chronic kidney disease.

Cervical cancer can be detected in the early, curable stage by the ________ test. a. gonorrhoeae b. Papanicolaou c. human papillomavirus d. vaginal pH

b. Papanicolaou Cancer of the uterine cervix is a neoplasm that can be detected in the early, curable stage by the Papanicolaou (Pap) test. The main cause of cervical cancer is certain human papillomavirus (HPV) types. Neisseria gonorrhoeae is a common causative agent in pelvic inflammatory disease. Changes in vaginal pH may be seen with vulvovaginitis.

Which condition is caused by a genetic defect? a. Acute pyelonephritis b. Polycystic kidney disease c. Hydroureter d. Incontinence

b. Polycystic kidney disease Polycystic kidney disease is caused by a genetic defect. Acute pyelonephritis, hydroureter, and incontinence are not caused by genetic defects.

Erection requires the release of nitrous oxide into the corpus cavernosum during sexual stimulation. a. False b. True

b. True Erection requires the release of nitrous oxide into the corpus cavernosum during sexual stimulation.

Infection can lead to bladder stone formation. a. False b. True

b. True Infection can lead to bladder stone formation.

The condition characterized by oliguria and hematuria is a. cystitis. b. acute glomerulonephritis. c. polycystic kidney disease. d. renal insufficiency.

b. acute glomerulonephritis. Acute glomerulonephritis is characterized by oliguria and hematuria. Polycystic kidney disease and renal insufficiency are not characterized by oliguria and hematuria. Cystitis is not characterized by oliguria.

Cryptorchidism is a. a consequence of gonorrhea. b. associated with an increased incidence of testicular cancer. c. an extremely uncommon disorder. d. rarely treated.

b. associated with an increased incidence of testicular cancer. Several studies have revealed an increased prevalence of testicular tumors in subjects with a history of cryptorchidism. The incidence of cryptorchidism is about 0.7% to 1.0% of male infants at 1 year of age. Because of the increased risk of malignancy and infertility, treatment at an early age to bring the testis into a normal scrotal position is recommended. The cause of the condition is uncertain but may be related to an intrinsic testicular defect or a subtle hormonal deficiency.

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

b. calcium. 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%.

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

b. genetically transmitted. Polycystic kidney disease is genetically transmitted. Polycystic kidney disease is a chronic disorder that progresses for several years. It is not caused by a streptococcal infection and is not associated with supernumerary kidney.

A primary laboratory finding in end-stage chronic renal disease is a. decreased blood urea nitrogen (BUN). b. increased serum creatinine. c. metabolic alkalosis. d. decreased serum sodium.

b. increased serum creatinine. End-stage chronic renal disease causes increased serum creatinine and blood urea nitrogen, because the dysfunctional kidneys are not able to excrete these metabolic waste products. Chronic renal failure causes increased blood urea nitrogen. Hyponatremia is not a primary laboratory finding in end-stage chronic renal disease. Metabolic alkalosis is not common with end-stage chronic renal disease.

The urinalysis finding most indicative of cystitis includes the presence of a. bacteria. b. nitrites. c. casts. d. WBCs and RBCs.

b. nitrites. Nitrites in the urine along with leukocyte esterase are definitive for cystitis. Urine may have a few WBCs and RBCs without the presence of cystitis. Casts may be present without cystitis. A few bacteria in the urine is common without the presence of cystitis.

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

b. pain. The most common sign/symptom of renal calculi is pain. Although nausea, vomiting, and hematuria may accompany renal colic, the most common sign/symptom of renal calculi is pain. Oliguria is not a frequent sign/symptom of renal calculi.

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

b. proteinuria. 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.

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. lumpectomy. b. radical mastectomy. c. modified radical mastectomy. d. mastectomy.

b. radical mastectomy. 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.

The main clinical manifestation of a kidney stone obstructing the ureter is a. urge incontinence. b. renal colic. c. oliguria. d. an abdominal mass.

b. renal colic. Renal colic is the flank pain that occurs with obstruction of the proximal ureter or renal pelvis. Oliguria may occur with kidney stone obstruction, but renal colic is the main clinical manifestation of this condition. Urge incontinence normally occurs when a kidney stone is obstructing the lower urinary tract. Kidney stones are small and located in a retroperitoneal position in the ureter, so they generally do not form a palpable mass.

The greatest risk factor for bladder cancer is a. recurrent bladder infections. b. smoking. c. low fluid intake. d. family history of bladder cancer.

b. smoking. Smoking is the greatest risk factor for bladder cancer. Although recurrent bladder infections, low fluid intake, and a family history of bladder cancer increase the risk of cancer resulting from inflammation, these are not the greatest risk factor.

Sudden, severe testicular pain is indicative of a. prostatitis. b. testicular torsion. c. testicular cancer. d. epididymitis.

b. testicular torsion. A twisting of the spermatic cord with subsequent testicular ischemia and infarction, testicular torsion, commonly presents with sudden onset of severe testicular pain. Prostatitis is manifested by a tender, swollen prostate. Testicular cancer has a slower, less dramatic presentation. Epididymitis can resemble testicular torsion, but usually presents with an enlarged, reddened, and tender scrotum, as opposed to a sudden onset of severe pain.

The normal post-void residual urine in the bladder is a.250 to 300 mL. b.less than 100 mL. c.150 to 200 mL. d.none of these; no normal residual volume is identified.

b.less than 100 mL. The normal post-void residual urine in the bladder is less than 100 mL. The normal post-void residual urine in the bladder is not 150 to 200 or 250 to 300 mL. The normal post-void residual urine in the bladder is identifiable and is less than 100 mL.

Which group is at the highest risk for urinary tract infection? a. Patients taking diuretics b. Adult males c. Sexually active women d. Infants and children

c. Sexually active women Sexually active women are at the highest risk for urinary tract infection. Infants and children, adult males, and patients taking diuretics are not at the highest risk for urinary tract infection.

The pathology report for a patient with penile cancer has this statement: The tumor involves the shaft of the penis. The cancer is at what stage? a. Stage IV b. Stage III c. Stage II d. Stage I

c. Stage II Penile carcinoma is staged as follows: Stage I: The lesion is limited to the glans or foreskin. Stage II: The tumor involves the shaft of the penis. Stage III: The inguinal nodes are involved, but the lesion is operable. Stage IV: Disseminated disease.

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

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

c. an immune complex reaction. Acute glomerulonephritis is an immune complex reaction that involves IgG. Acute glomerulonephritis is not caused by renal ischemia, bacterial invasion, or anaphylactic reaction.

Scrotal pain in males and labial pain in females may accompany renal pain as a result of a. muscle tension. b. associated infections. c. associated dermatomes. d. anxiety.

c. associated dermatomes. Dermatomes in the T10-L1 spinal cord segment can result in scrotal and labial pain in association with renal pain. Scrotal and labial pain in association with renal pain are not as a result of associated infection, muscle tension, or anxiety.

Detrusor muscle overactivity can be improved by administration of a. nonsteroidal antiinflammatory agents. b. cholinergic agents. c. botulinum toxin. d. alpha-receptor agonists.

c. botulinum toxin. Detrusor muscle overactivity can be improved by administration of botulinum toxin. Alpha-receptor agonists will not treat detrusor muscle overactivity. Anticholinergic drugs will treat this condition. NSAIDS are for pain, inflammation, and fever.

The type of glomerulonephritis which is most likely to result in a swift decline in renal function that then progresses to acute kidney injury is a. acute glomerulonephritis. b. chronic glomerulonephritis. c. crescentic glomerulonephritis. d. post-streptococcal glomerulonephritis.

c. crescentic glomerulonephritis. Crescentic glomerulonephritis results in a swift decline in renal function that progresses to acute renal injury. Acute glomerulonephritis, post-streptococcal glomerulonephritis, and chronic glomerulonephritis do not develop into acute renal injury.

A 32-year-old female complaining of severe pain with menstruation and inability to participate in her routine household activities is likely experiencing a. amenorrhea. b. menorrhagia. c. dysmenorrhea. d. metrorrhagia.

c. dysmenorrhea. Dysmenorrhea is menstruation that is painful enough to limit normal activity or to cause a woman to seek health care. Menorrhagia is an often debilitating increase in the amount or duration of menstrual bleeding. Amenorrhea is the absence or suppression of menstruation in a female aged 16 years or older; it occurs if a woman misses three or more periods in a row. Metrorrhagia , or bleeding between menstrual periods, usually results from slight physiologic bleeding from the endometrium during ovulation, but may also result from other causes such as uterine malignancy, cervical erosions, and endometrial polyps or as a side effect of estrogen therapy.

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

c. hematuria. Hematuria is a frequent sign of renal cancer. Bacteria and protein in the urine are not associated with renal cancer. Intermittent urinary colic is associated with renal calculi. Red blood cell casts in the urine are associated with glomerulonephritis.

In addition to renal colic pain, signs or symptoms of ureteral stones may frequently include a. postrenal renal failure. b. urinary urgency. c. hematuria. d. proteinuria.

c. hematuria. Hematuria often occurs with ureteral stones as a result of irritation of the ureteral wall. Postrenal renal failure, urinary urgency, and proteinuria do not generally occur with ureteral stones.

The consequence of an upper urinary tract obstruction in a single ureter is a. dilation of the urethra. b. anuria. c. hydronephrosis. d. kidney stone formation.

c. hydronephrosis. Dilation of the urinary tract occurs proximal to the obstruction. In this case, the proximal ureter and renal pelvis would enlarge, causing hydronephrosis. Kidney stones are causes, rather than consequences, of an upper urinary tract obstruction. Dilation of the urinary tract occurs proximal to the obstruction. Urine production will continue to occur if one ureter is blocked.

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

c. hyperemesis gravidarum. 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.

At his most recent clinic visit, a patient with end-stage renal disease is noted to have edema, congestive signs in the pulmonary system, and a pericardial friction rub. Appropriate therapy at this time would include a. fluid restriction. b. antibiotics. c. initiation of dialysis. d. phlebotomy.

c. initiation of dialysis. Dialysis is the appropriate therapy at end-stage renal disease. Although fluid restriction may be appropriate at some point in renal failure, it will not correct the identified problems. Antibiotics will not correct the problems identified and may further impair remaining renal function. Phlebotomy will not correct the identified problems.

The most likely cause of anemia in a patient with end-stage renal disease is a. blood loss secondary to hematuria. b. iron deficiency. c. insufficient erythropoietin. d. vitamin B12 deficiency secondary to deficient intrinsic factor.

c. insufficient erythropoietin. The most likely cause of anemia in a patient with end-stage renal disease is insufficient erythropoietin secretion by the kidney, which is necessary for RBC production. Blood loss secondary to hematuria, vitamin B 12 deficiency secondary to deficient intrinsic factor, and iron deficiency are not the most likely causes of anemia in a patient with end-stage renal disease.

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

c. leiomyomas. 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.

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

c. man who has chronic urinary tract infections. 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.

It is true that fibrocystic breast disease a. is a contraindication for progesterone birth control pills. b. commonly progresses to breast cancer. c. may be exacerbated by methylxanthines. d. is characterized by painless breast lumps.

c. may be exacerbated by methylxanthines. In fibrocystic breast disease, it is thought that methylxanthines tend to stimulate cyclic adenosine monophosphate and thus increase metabolic activity in the breast. Nutritional therapies have shown success in some women, particularly in avoidance of foods with methylxanthines such as tea, coffee, cola, and chocolate. Recent research has disproved the theory that fibrocystic breast disease leads to cancer. Fibrocystic breast disease is characterized by tenderness or pain in one or both breasts. Oral contraceptives have been recommended to control symptoms of fibrocystic breast disease.

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

c. nephrotic syndrome. 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.

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

c. pelvic muscle weakness. 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.

One cause of an extrinsic renal system obstruction is a. papillary necrosis. b. neurogenic bladder. c. pelvic tumor. d. clot.

c. pelvic tumor. Pelvic tumor is one cause of an extrinsic renal system obstruction. Clot is not a cause of an extrinsic renal system obstruction. Neurogenic blander is not the cause of an extrinsic renal system obstruction. Papillary necrosis is not the cause of an extrinsic renal system obstruction.

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

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

The most common cause of ischemic acute tubular necrosis (ATN) in the United States is a. hypotension. b. renal artery stenosis. c. sepsis. d. hypovolemia.

c. sepsis. Sepsis is the most common cause of ischemic ATN in the United States. Hypotension, hypovolemia, and renal artery stenosis are not the most common causes of ischemic ATN.

The most helpful laboratory value in monitoring the progression of declining renal function is a. serum potassium. b. mental status changes. c. serum creatinine. d. blood urea nitrogen.

c. serum creatinine. Serum creatinine is the most stable and accurate reflection of renal function. Serum potassium is affected by many factors and thus not the most helpful value in monitoring the progression of this disease. Blood urea nitrogen is not as stable as serum creatinine; it is affected by muscle breakdown, protein intake, and so forth. Mental status changes can occur as a result of multiple factors other than renal function.

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

c. struvite 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.

Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because a. erythropoietin secretion is impaired. b. excess potassium leaches calcium from bone. c. they are deficient in active vitamin D. d. urea causes demineralization of bone.

c. they are deficient in active vitamin D. Vitamin D, required for calcium absorption in the digestive tract, is activated in the kidneys. With chronic renal failure, vitamin D is not activated. Hyperkalemia does not influence bone mineralization. Erythropoietin is important for red blood cell production. Urea does not cause renal osteodystrophy.

The most common cause of intrinsic kidney injury is _____ injury. a. interstitial b. vascular c. tubular d. glomerular

c. tubular Tubular injury (acute tubular necrosis) is the most common cause of acute kidney injury. Glomerular, interstitial, and vascular injury are not the most common causes of acute kidney injury.

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

c.protein By definition, nephrotic syndrome involves loss of large amounts of protein in the urine. Hematuria and glucose loss in urine are not characteristic of nephrotic syndrome. Sodium and water are reabsorbed in nephrotic syndrome.

The effect on the renal tubules during the postoliguric phase of acute tubular necrosis involves a. reconstruction of the basement membrane. b. blocking the tubule lumens by dead cells. c. making the glomeruli patent again. d. regeneration of the renal tubular epithelium.

d. regeneration of the renal tubular epithelium. During the postoliguric phase of acute tubular necrosis, the renal tubular epithelium is regenerating. Disruption of basement membranes is not characteristic of acute tubular necrosis. Blockage of the tubule lumens would cause oliguria. The glomeruli are not clogged during acute tubular necrosis.

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. "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." b. "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." c. "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." 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. "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." 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.

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

d. 75% to 90% 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 HPV vaccine is recommended for 11- to 12-year-old girls, but can be administered to girls as young as _____ years of age. a. 10 b. 8 c. 7 d. 9

d. 9 The HPV vaccine is recommended for 11- to 12-year-old girls, but can be administered to girls as young as 9 years of age. The HPV vaccine is recommended for girls above the age of 9. The HPV vaccine is not recommended for females under the age of 9. The vaccine also is recommended for 13- to 26-year-old females who have not yet received or completed the vaccine series.

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

d. ACE inhibitors 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 microorganism that causes the vast majority of urinary tract infections is a. herpes simplex virus. b. Klebsiella. c. Candida albicans. d. Escherichia coli.

d. Escherichia coli. 80% of all UTIs are caused by Escherichia coli. Klebsiella, herpes simplex virus, and Candida albicans are not the most common infecting microorganisms in UTIs.

In patients with polycystic kidney disease, renal failure is expected to progress over time as the cystic process destroys more nephrons. At what point will a patient reach end-stage renal disease? a. Greater than 15% b. Greater than 25% nephron loss c. Greater than 50% nephron loss d. Greater than 90% nephron loss

d. Greater than 90% nephron loss End-stage renal disease occurs when greater than 90% of the nephrons have been lost. End-stage renal disease is possible to predict based on nephron loss. It occurs when greater than 90% (not 15%, 25%, or 50%) of the nephrons have been lost.

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

d. absent or diminished levels of progesterone. 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.

Absence of menstruation is called a. menorrhagia. b. dysmenorrhea. c. metrorrhagia. d. amenorrhea.

d. amenorrhea. Amenorrhea is the absence or suppression of menstruation in a female aged 16 or older. Metrorrhagia is bleeding between menstrual periods. Menorrhagia is an often debilitating increase in the amount or duration of menstrual bleeding. Dysmenorrhea is menstruation that is painful enough to limit normal activity.

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

d. cardinal ligaments. 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.

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

d. dehydration. Dehydration is a major modifiable risk factor for nephrolithiasis. Family history is not modifiable. Smoking and alcohol consumption are not a major risk factors for nephrolithiasis.

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

d. fever. Acute pyelonephritis often leads to fever. Acute pyelonephritis does not typically lead to oliguria, edema, or hypertension.

Appropriate therapy for prerenal kidney injury includes a. potassium supplementation. b. fluid restriction. c. protein restriction. d. fluid administration.

d. fluid administration. Appropriate therapy for prerenal oliguria includes fluid administration; most often prerenal kidney injury is because of fluid volume deficit. Potassium supplements are not appropriate in prerenal oliguria, as potassium is not being excreted. Appropriate therapy for prerenal oliguria includes fluid administration. Protein restriction is not indicated in prerenal oliguria.

A patient who has difficulty walking without assistance is incontinent of urine when help doesn't get to her quickly enough. The term for this type of incontinence is a. stress. b. urge. c. extraurethral. d. functional.

d. functional. Functional incontinence is secondary to a motor or cognitive deficit. Extraurethral incontinence occurs when an individual has a fistula. Urge incontinence involves immediate voiding after the urge occurs. Stress incontinence occurs from increased abdominal pressure and sphincter laxity.

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

d. hypertension. 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.

A change occurring in a pregnant woman that is indicative of a potential disorder is a. 30% to 40% increase in cardiac output. b. increased metabolic rate. c. increased oxygen consumption. d. increased urinary protein.

d. increased urinary protein. Pregnancy-induced hypertension is characterized by a rapid rise in arterial blood pressure associated with the loss of large amounts of protein in the urine. An increased metabolic rate is a normal finding in a pregnant woman. Increased cardiac output would be an expected finding during pregnancy. Pregnant women are expected to have an increase in oxygen consumption during pregnancy.

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

d. intravenous therapy. 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.

One of the most common causes of acute tubular necrosis (ATN) is a. cytotoxic agents. b. prolonged postrenal kidney injury. c. immune reaction. d. ischemic conditions.

d. ischemic conditions. Ischemia and nephrotoxic agents are the most common causes of ATN. Cytotoxic agents, immune reaction, and prolonged postrenal kidney injury are not the most common causes of ATN.

If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience a. oliguria and sodium retention. b. infections and sepsis. c. magnesium and phosphorus loss in urine. d. polyuria and sodium wasting.

d. polyuria and sodium wasting. If ATN does not resolve, the high blood urea nitrogen (BUN) creates osmotic diuresis; the urine is high in sodium content. Oliguria and sodium retention, infections and sepsis, and magnesium and phosphorous loss in the urine do not result from tubular necrosis and tubular dysfunction.

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

d. severe hypotension. Prerenal acute kidney injury occurs when blood flow to the kidneys is compromised. Severe hypotension from heart failure, hypovolemia, or shock is a leading cause. Glomerulonephritis does not cause prerenal acute kidney injury, because the glomeruli are located within the kidneys. Bilateral kidney stones do not cause prerenal acute kidney injury, because they are located distal to the nephrons. Acute tubular necrosis does not cause prerenal acute kidney injury, because the renal tubules are located within the kidneys.

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. his glomeruli have been damaged by his own immune system. b. his liver is extremely active in synthesizing protein. c. his renal tubules are full of cellular debris. d. the glomerular membrane has increased permeability.

d. the glomerular membrane has increased permeability. 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.

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

d. urge incontinence. 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.

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. Gout may lead to uric acid crystals because of elevated serum uric acid levels. Calcium oxalate, not potassium oxalate, stones are associated with hypercalcemia. Struvite calculi are associated with urinary tract infections. Cysteine calculi are associated with a genetic defect.