check your understanding 27, 28, 29, 31, 33

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

True

The prognosis of penile carcinoma depends upon the stage of the disease. a. True b. False

a. True

Calcium oxylate stone formation is facilitated by a. hypercalciuria. b. protein intake. c. hypoparathyroidism. 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.

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

a. 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 infection frequently associated with development of postinfectious acute glomerulonephritis is a. throat infection. b. pneumonia. c. endocarditis. d. urinary tract infection.

a. throat infection. Group A B-hemolytic Streptococcus infection of the throat (strep throat) frequently is associated with development of postinfectious acute glomerulonephritis. Pneumonia, endocarditis, and urinary tract infection are not commonly associated with development of postinfectious acute glomerulonephritis.

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

b. 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.

The greatest risk factor for bladder cancer is a. low fluid intake. b. smoking. c. recurrent bladder infections. 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. epididymitis. b. testicular torsion. c. prostatitis. d. testicular cancer.

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.

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

c. 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.

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

a. 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 patient most at risk for postrenal acute kidney injury is a(n) a. elderly patient with hypertrophy of the prostate. b. young child with reflux at the ureterovesical junction. c. middle-aged woman with bladder infection. d. patient who has both hypertension and diabetes.

a. elderly patient with hypertrophy of the prostate. Postrenal acute kidney injury is caused by obstruction in the urinary tract below the level of the kidneys. Elderly men with prostatic hypertrophy are at risk for urinary retention. Bladder infection generally does not obstruct urine flow. Ureterovesical junction reflux is likely to cause pyelonephritis, but not obstruction. Diabetes and hypertension result in intra-renal disease.

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

a. 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.

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

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

a. 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.

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.

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. "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." b. "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." 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. "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. "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.

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.

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

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

b. 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.

Endometriosis is a condition in which a. an abnormal Pap smear is diagnostic. b. ectopic endometrial tissue is present. c. the endometrium proliferates and does not shed. d. the endometrium sloughs continuously.

b. ectopic endometrial tissue is present. Endometriosis is the presence of endometrial tissue outside the lining of the uterine cavity. The only normal location for endometrial tissue is the endometrial lining of the uterus, but with endometriosis, the tissue is found outside the uterine cavity. Endometriosis is not diagnosed with a Pap smear. Diagnosis is made by a physician based on symptoms. The most prominent symptom of endometriosis is dysmenorrheal.

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

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

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.

A common component of renal calculi is a. creatinine. b. cholesterol. c. calcium. d. urobilirubin.

c. calcium. Renal calculi most commonly are formed from calcium oxalate. Cholesterol, creatinine, and urobilirubin are not common components of renal calculi.

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, 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 leaks into his bowel and bacteria from the bowel leak into the bladder, where they grow and make a bladder infection." c. "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." d. "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."

c. "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.

Anemia in people who have end-stage chronic renal disease is caused by a. increased secretion of aldosterone. b. poor appetite, with lack of iron intake. c. decreased secretion of erythropoietin. d. chronic loss of blood in the urine.

c. decreased secretion of erythropoietin. Decreased secretion of erythropoietin is the major cause of anemia in end-stage chronic renal disease. Hematuria is not a characteristic of end-stage chronic renal disease. Iron deficiency does not cause the anemia in end-stage chronic renal disease. Aldosterone levels do not contribute to anemia.

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. neuroses. c. interstitial cystitis. d. ureteral stone.

c. 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.

It is true that fibrocystic breast disease a. commonly progresses to breast cancer. b. is a contraindication for progesterone birth control pills. 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.

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

c. 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.

Dysfunctional uterine bleeding (DUB) is caused by a. endometrial fibroid tumors. b. endometrial inflammation. 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.

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

d. 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.

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

d. 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.

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

d. bilateral kidney stones. 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.

Uterine prolapse is caused by a relaxation of the a. abdominal organs. b. cervix. c. vaginal musculature. 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 patient diagnosed with a micropenis must be evaluated for a. female sex assignment. b. vascular abnormalities. c. epispadias. d. endocrine disorders.

d. 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 associated with end-stage chronic renal disease that is the most immediately life threatening is a. azotemia. b. hypertension. c. increased creatinine. d. hyperkalemia.

d. hyperkalemia. Hyperkalemia from decreased renal excretion of potassium can cause dysrhythmias and cardiac arrest. While azotemia, increased creatinine, and hypertension are consequences of end-stage chronic renal disease, they usually are not acutely life threatening.

A change occurring in a pregnant woman that is indicative of a potential disorder is a. increased oxygen consumption. b. 30% to 40% increase in cardiac output. c. increased metabolic rate. 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 disorder characterized by a neurologic lesion that affects bladder control is a. bladder prolapse. b. detrusor inactivity. c. cystitis. d. neurogenic bladder.

d. 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.

A person is unaware that his bladder is full of urine, but complains that he is leaking urine almost constantly. The most accurate term for this type of incontinence is a. urge. b. stress. c. mixed. d. overflow.

d. overflow. This type of incontinence is called overflow incontinence. Stress incontinence is because of increased intra-abdominal pressure. Urge incontinence is associated with a sudden need to void and involuntary leakage of urine. Mixed incontinence is a combination of both stress incontinence and urge incontinence.

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

d. 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.

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

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