Patho Final

The defining characteristic of severe acute kidney injury is: proteinuria. oliguria. hematuria. diuresis.

Oliguria

In the liver, ammonia is converted to: amino acids. ketoacids. urea. bile salts.

Urea

Which one of the following renal structures is not part of a nephron? Loop of Henle Ureter Proximal convoluted tubule Collecting duct

Ureter

The pain of appendicitis usually begins in the periumbilical area and then migrates to the: right upper quadrant. right lower quadrant. left upper quadrant. left lower quadrant.

right lower quadrant

Severe trauma can cause stress ulcers that often first manifest with: abdominal pain. peritonitis. severe bleeding. dumping syndrome.

severe bleeding

A major risk factor for developing bladder cancer is: exposure to porphyrins. urethral obstruction. bacteriuria. smoking.

smoking

Tissue damage in acute pancreatitis is caused by: inappropriate activation of pancreatic enzymes. hydrochloric acid reflux into the pancreatic duct. autoimmune destruction of the pancreas. insulin toxicity and beta cell hyperplasia.

inappropriate activation of pancreatic enzymes

Mr. Roswell had a very painful sore throat 3 weeks ago and now he has acute post-streptococcal glomerulonephritis. He says, "Why is my urine pink?" Choose the best response. 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 pink. 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 pink. 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 pink. 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 pink.

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 pink.

Devin Prentiss, age 3, has vesicoureteral reflux. "Why does that make him have so many bladder infections?" says his mother. Choose the best response to complete this sentence: "When he urinates: A. 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. 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. urine leaks into his bowel and bacteria from the bowel leak into the bladder, where they grow and make a bladder infection." D. urine stays in his bladder and the normal bacteria that live in the bladder have a chance to grow and cause a bladder infection."

B. urine runs back toward his kidneys and then into the bladder again, making it easier for bacteria to grow if they reach the bladder

Functions of the liver include all of the following except: glucose homeostasis. synthesis of plasma proteins. metabolic detoxification. secretion of lipase.

Secretion of lipase

Which of the following conditions causes prerenal acute kidney injury? Severe hypotension Glomerulonephritis Bilateral kidney stones Acute tubular necrosis

Severe hypotension

What causes anemia in people who have end-stage chronic renal disease? Chronic loss of blood in the urine Poor appetite with lack of iron intake Decreased secretion of erythropoietin Increased secretion of aldosterone

Decreased secretion of erythropoietin

Which one of the following hormones is produced and secreted by the juxtaglomerular apparatus in response to low blood pressure? Renin Aldosterone Antidiuretic hormone Natriuretic peptides

Renin

In which abdominal quadrant is the appendix located? Right upper Right lower Left upper Left lower

Right lower

Which cells produce digestive enzymes in the pancreas? Acinar Duct Alpha Beta

Acinar

Which of the following conditions is characterized by oliguria and hematuria? Acute glomerulonephritis Polycystic kidney disease Cystitis Renal insufficiency

Acute glomerulonephritis

Which of the following conditions causes postrenal acute kidney injury? Severe hypotension Glomerulonephritis Bilateral kidney stones Acute tubular necrosis

Bilateral kidney stones

Mr. Jenson has a kidney stone and is doubled up with pain. After he is given appropriate opioids, his wife says, "I don't understand why his pain kept coming and going. When I had appendicitis, that pain just stayed all the time." What is the physiology that should underlie your response? Ureters use peristalsis and gravity to move urine. Ureters insert into the bladder at an angle. In men, the prostate gland surrounds the urethra. In men, the urethra is longer than in women.

Ureters use peristalsis and gravity to move urine

The structure that carries urine from the bladder to the exterior of the body is called the: urinary meatus. urethra. ureter. terminal duct.

Urethra

In addition to cystitis, which of the following is a risk factor for development of pyelonephritis? Urinary retention and reflux Nephrotic syndrome Respiratory disease Glomerulonephritis

Urinary retention and reflux

The most common causes of liver cirrhosis are hepatitis C and: alcoholism. cocaine abuse. antibiotic overdose. liver cancer.

alcoholism

Signs and symptoms of hepatic encephalopathy are due to increased blood levels of: ammonia. potassium. urea. creatinine.

ammonia

Which of the following conditions is a glomerular disorder? Pyelonephritis Obstructive uropathy Interstitial cystitis Nephrotic syndrome

Nephrotic syndrome

Which of the following accurately describes renal insufficiency? 25% of the nephrons are not functional. 50% of the nephrons are not functional. 75% to 90% of the nephrons are not functional. More than 90% of the nephrons are not functional.

75%-90% of the nephrons are not functional

Which of the following changes will decrease the glomerular filtration rate? A. Increased hydrostatic pressure in Bowman capsule B. Decreased capillary colloid osmotic pressure C. Moderately increased arterial blood pressure D. All of the changes listed in the other answers will decrease glomerular filtration rate.

A. Increased hydrostatic pressure in Bowman capsule

Mrs. Jasper missed two dialysis sessions when her husband became ill and was unable to drive her. Her concerned neighbor called a cab and went with her to dialysis, where numerous imbalances were detected. Choose and interpret correctly the assessment findings that would be most likely before dialysis, given this situation. This question may have more than one correct answer. Choose all that apply. A. Lethargy due to metabolic acidosis and increased BUN B. Skeletal muscle weakness and possible cardiac dysrhythmias due to hyperkalemia C. Positive Chvostek and Trousseau signs due to hypomagnesemia D. Weight gain of several pounds since her last dialysis session due to hypernatremia E. Deep rapid breathing due to compensatory mechanism for metabolic acidosis

A. Lethargy due to metabolic acidosis and increased BUN B. Skeletal muscle weakness and possible cardiac dysrhythmias due to hyperkalemia E. Deep, rapid breathing due to compensatory mechanism

Which one of the following substances normally does not get filtered at the glomerulus? Albumin Glucose Sodium Creatinine

Albumin

Why does a person who has nephrotic syndrome have hypoalbuminemia? Hepatocyte failure decreases albumin synthesis. Albumin is excreted in the urine. Albumin leaks into the interstitial spaces. Malnutrition is part of nephrotic syndrome.

Albumin is excreted in the urine

Activation of the renin-angiotensin system stimulates the secretion of: antidiuretic hormone. aldosterone. atrial natriuretic peptides. cortisol.

Aldosterone

Individuals with chronic gastritis are at risk for: gastric cancer. achlorhydria. gastrointestinal bleeding. All of the above

All of the above

Risk factors for renal cell carcinoma include which of the following? Asbestos exposure Cigarette smoking Obesity All of the other answers are correct.

All of the other answers are correct

If the posterior pituitary is damaged, which one of the following hormones is affected? Renin Antidiuretic hormone Erythropoietin Aldosterone

Antidiuretic hormone

Mrs. Jasper has end-stage chronic renal disease (ESRD). She missed two dialysis sessions when her husband became ill and was unable to drive. In addition to having clinical manifestations of numerous imbalances detected at her next dialysis session, Mrs. Jasper says her skin is very itchy. Based on her statement about itching, what additional assessment(s) should you perform? Draw blood for arterial blood gases per unit protocol Ask about aching joints and assess for inflamed eyes Measure her blood pressure lying and then standing Listen to lung sounds, especially for wheezing

Ask about aching joints and assess for inflamed eyes

Mr. Thomas was injured severely in a motor vehicle accident and lost a lot of blood. When the emergency personnel extracted him from the wreckage, his blood pressure was 40/undetectable. Now he is in the hospital with acute kidney injury as well as multiple broken bones and lacerations. "What is the 'prerenal' business that the doctor keeps mentioning?" says Mrs. Thomas. Choose the best response to complete this sentence: "The word 'prerenal" means that: 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."

Which one of the following statements correctly describes a direct end-effect of the renin-angiotensin-aldosterone system? A. Renin promotes the renal excretion of sodium and water in the proximal tubules. B. Aldosterone increases renal reabsorption of water and sodium. C. Angiotensin II causes systemic vasodilation. D. Angiotensin I promotes water excretion by the kidneys without affecting sodium reabsorption.

B. Aldosterone increases renal reabsorption of water and sodium

Billy has nephrotic syndrome. "Tell me what causes Billy's urine to be so full of protein," says Billy's father. Which of the following mechanisms should be the basis for your response, which you then will explain in layperson language? A. His glomeruli have been damaged by his own immune system. B. Glomerular basement membranes have lost their negative charge. C. His liver is extremely active in synthesizing protein. D. His renal tubules are full of cellular debris.

B. Glomerular basement membranes have lost their negative charge

The major cause of glomerulonephritis is: A. infection of the glomerular capsule secondary to a urinary tract infection. B. immune system damage to glomeruli. C. hydronephrosis from kidney stones. D. Streptococcus infection in the bloodstream that migrates to the glomerulus.

B. Immune system damage to glomeruli

Which of the following statements explains why portal hypertension leads to ascites? Hepatosplenomegaly develops. Blood backs up in the mesenteric veins. Esophageal varices form in the lower esophagus. Congestion causes internal hemorrhoids.

Blood backs up in the mesenteric veins

"Mr. Kendall has acute tubular necrosis (ATN)," says Nurse Newbie. "I've been taking care of him for over 2 weeks. After my days off, I come back and find that he has mild polyuria. I'm really worried at this change, but no one else is. What's going on?" Choose the best response. A. 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. B. 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. C. 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. D. 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. 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

What causes the tachycardia and lightheadedness associated with the dumping syndrome? A. Decreased insulin release from lack of gastric stimulation causes hyperglycemia, with tachycardia and lightheadedness. B. Abrupt entry of chyme into the small intestine distends it, triggering reflex tachycardia and lightheadedness. C. Osmosis draws water rapidly into the small intestine, causing hypovolemia, with tachycardia and lightheadedness. D. Inappropriate contraction of the pyloric sphincter causes extreme pain, with tachycardia and lightheadedness.

C. Osmosis draws water rapidly into the small intestine, causing hypovolemia, with tachycardia and lightheadedness

What is the difference between stress incontinence and urge incontinence? A. Stress incontinence occurs in women, whereas urge incontinence occurs in both men and women. B. Stress incontinence occurs during sleep, whereas urge incontinence occurs during the waking hours. C. Stress incontinence is caused by a sphincter problem, whereas urge incontinence is caused by a problem with the detrusor muscle. D. Stress incontinence is caused by a detrusor muscle problem, whereas urge incontinence is caused by a neurological problem.

C. Stress incontinence is caused by a sphincter problem, whereas urge incontinence is caused by a problem with the detrusor muscle

Which of the following is a common component of renal calculi? Calcium Cholesterol Creatinine Urobilirubin

Calcium

Which of the following disorders can cause lower gastrointestinal bleeding? Mallory-Weiss tear Peptic ulcer Cancer Hernia

Cancer

Which one of the following substances do hepatocytes secrete into bile? Stercobilin Unconjugated bilirubin Conjugated bilirubin Iron

Conjugated bilirubin

A person who has lactase deficiency typically develops: cramping and diarrhea after drinking milk. constipation after eating cheese. gas and bloating after eating a high-fat meal. jaundice after eating red meat.

Cramping and diarrhea after drinking milk

The duct that carries bile into the gallbladder is the: common bile duct. cystic duct. pancreatic duct. accessory duct.

Cystic duct

What is reflux esophagitis? A. Autoimmune destruction of the esophageal mucosa. B. Dysplasia of the epithelial lining of the esophagus. C. Congenital anomaly of the esophagus. D. Inflammatory response to gastric contents in the esophagus.

D. Inflammatory response to gastric contents in the esophagus

Bilirubin comes from: bile salt metabolism. degradation of fatty acids. accumulation of albumin. destruction of aged red blood cells.

Destruction of aged red blood cells

Diverticulosis is associated with which of the following dietary situations? Lactose deficiency Diet high in refined foods Iron deficiency High intake of dietary fiber

Diet high in refined foods

Which of the following symptoms occurs with both cystitis and pyelonephritis? CVA tenderness Suprapubic pain Dysuria Fever and chills

Dysuria

Which hormone stimulates the production of red blood cells in the bone marrow? Aldosterone Renin Creatinine Erythropoietin

Erythropoietin

What is the consequence of an upper urinary tract obstruction in a single ureter? Kidney stone formation Hydronephrosis Dilation of the urethra Anuria

Hydronephrosis

Which one of the following microorganisms causes the vast majority of urinary tract infections (UTIs)? Klebsiella Escherichia coli Herpes simplex virus Candida albicans

Escherichia coli

Mrs. Mendoza has severe osteoarthritis and is unable to walk without assistance. She put on her call light 45 minutes ago, but an emergency in another room kept all available personnel very busy. As you enter the room in response to the call light, Mrs. Mendoza says, "Oh, how embarrassing! I just wet the bed 5 minutes ago. I haven't wet a bed since I was a small child! I called you but everyone was busy. I held it as long as I could and then it just came." What is the technical term that you should use with another health professional to describe Mrs. Mendoza's incontinence? Extraurethral incontinence Functional incontinence Urge incontinence Stress incontinence

Functional incontinence

Which one of the following organs is responsible for storing bile between meals? Liver Pancreas Spleen Gallbladder

Gallbladder

In the kidneys, filtration takes place at the: nephron. calyx. glomerulus. juxtaglomerular apparatus.

Glomerulus

Which of the following causes jaundice due to increased unconjugated bilirubin? Hemolytic anemia Gallstones Blocked bile duct Hypertension

Hemolytic anemia

Which of the following types of hepatitis can be acquired from ingesting contaminated food and may cause acute fever, abdominal pain, and jaundice but not fulminant liver failure? Hepatitis A Hepatitis B Hepatitis C Hepatitis A, B, and C

Hepatitis A

Which of the following types of hepatitis can be acquired from contaminated blood or other body fluids and may cause acute fever, abdominal pain, jaundice, and cirrhosis? Hepatitis A Hepatitis B Hepatitis C Hepatitis B and C

Hepatitis B and C

Why does a person who has nephrotic syndrome have hyperlipidemia? Hepatocytes synthesize excessive lipids. Lipids are not excreted in the urine. Body fats are catabolized. Muscles stop burning triglycerides for energy.

Hepatocytes synthesize excessive lipids

Which of the following substances are secreted actively into the renal tubules? Hydrogen and potassium ions Sodium and chloride ions Bicarbonate ions and carbonic acid Phosphate and calcium ions

Hydrogen and potassium ions

Which of the following conditions associated with end-stage chronic renal disease is the most immediately life-threatening? Azotemia Increased creatinine Hypertension Hyperkalemia

Hyperkalemia

Which of the following conditions is known to cause chronic kidney disease? Hypertension Chronic obstructive pulmonary disease Myocarditis Pernicious anemia

Hypertension

Acute tubular necrosis can occur from all of the following problems except: increased ammonia levels from liver failure. contrast dyes used for radiologic studies. ischemia due to hypovolemia. antibiotics that are nephrotoxic.

Increased ammonia levels from liver failure

Jaundice in a person with bile duct obstruction is due primarily to which of the following? Decreased unconjugated bilirubin Increased unconjugated bilirubin Decreased conjugated bilirubin Increased conjugated bilirubin

Increased conjugated bilirubin

Parasympathetic stimulation causes: inhibition of intestinal smooth muscle activity. increased gastric and pancreatic secretions. decreased blood flow to the digestive tract. relaxation of the external anal sphincter.

Increased gastric and pancreatic secretions

Which of the following is a primary laboratory finding in end-stage chronic renal disease? Decreased blood urea nitrogen (BUN) Decreased serum sodium Metabolic alkalosis Increased serum creatinine

Increased serum creatinine

What is the normal location of the gastroesophageal junction? Above the diaphragm In front of the diaphragm Just below the diaphragm Behind the diaphragm

Just below the diaphragm

Which one of the following structures normally prevents reflux of stomach contents into the esophagus? Pyloric sphincter Fundus Upper esophageal sphincter Lower esophageal sphincter

Lower esophageal sphincter

Which of these individuals is at highest risk of pyelonephritis and therefore needs you to monitor for signs of its occurrence? Woman who is paraplegic Woman who is pregnant Man who has glomerulonephritis Man who has cystitis

Man who has cystitis

Which of the following structures are tiny projections of the intestinal mucosal lining that form the brush border and increase the surface area for absorption? Cilia Lacteals Mesenteries Microvilli

Microvilli

What are the layers of the intestinal wall, in order, beginning at the lumen? Mucosa, submucosa, muscularis, serosa Villi, subvilli, lymphatic, muscle Mucosa, submucosa, serosa, muscularis Serosa, mucosa, submucosa, muscularis

Mucosa, submucosa, muscularis, serosa

Which of the following disorders is characterized by a neurologic lesion that affects bladder control? Neurogenic bladder Detrusor overactivity Bladder prolapse Cystitis

Neurogenic bladder

Which of the following types of diarrhea can be caused by inability to digest lactose? Secretory Neurogenic Osmotic Motility

Osmotic

Which of the following disorders is characterized by poor digestion of fats, proteins, and carbohydrates? Pancreatic insufficiency Gluten-sensitive enteropathy Bile salt deficiency Lactase deficiency

Pancreatic insufficiency

Which capillaries surround the proximal and distal convoluted tubules and are involved in reabsorbing filtered substances back into the blood? Glomerular capillaries Renal papillae Peritubular capillaries Arcuate vessels

Peritubular capillaries

Which of the following conditions is caused by a genetic defect? Acute pyelonephritis Hydroureter Incontinence Polycystic kidney disease

Polycystic kidney disease

Mucus production in the stomach is stimulated by: histamine. gastrin. trypsinogen. prostaglandins.

Prostaglandins

Obstruction of the lower urinary tract in men often is caused by: congenital stricture of a calyx. prostate enlargement. pelvic organ prolapse. urinary tract infection.

Prostate enlargement

Trypsinogen is the inactive form of a pancreatic: amylase. protease. lipase. hormone.

Protease

Nephrotic syndrome involves loss of large amounts of what substance in the urine? Blood Sodium Glucose Protein

Protein

Which of the following types of glomerulonephritis is most likely to develop into acute kidney injury? Acute glomerulonephritis Rapidly progressive glomerulonephritis Post-streptococcal glomerulonephritis Chronic glomerulonephritis

Rapidly progressive glomerulonephritis

Which of the following is associated with vesicoureteral reflux? Increased serum creatinine Recurrent cystitis Polycystic renal disease Proteinuria

Recurrent cystitis

The main clinical manifestation of a kidney stone obstructing the ureter is: pyuria. renal colic. urge incontinence. an abdominal mass.

Renal colic

The renal structure that drains urine directly into the ureter is the: minor calyx. urethra. collecting duct. renal pelvis.

Renal pelvis

Increased levels of aldosterone stimulate reabsorption of which of the following molecules? Sodium and water Potassium and sodium Glucose and sodium Water only

Sodium and water

What happens in the renal tubules during the diuretic phase of acute tubular necrosis? The basement membrane is being reconstructed. Dead cells are blocking the tubule lumens. The glomeruli are becoming patent again. The renal tubular epithelium is regenerating.

The renal tubular epithelium is regenerating

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

They are deficient in active vitamin D

Which of the following infections frequently is associated with development of acute post-streptococcal glomerulonephritis? Pneumonia Throat infection Endocarditis Urinary tract infection

Throat infection

Which of the following factors has a major influence on formation of renal calculi? Urine sodium levels Serum lactate levels Urine pH Urine creatinine levels

Urine pH

What normally keeps urine from moving back toward the kidneys when the bladder contracts? Valves at the junction of the ureters and the bladder Valves at the junction of the urethras and the bladder Constriction of the prostate gland Constriction of the cremaster muscle

Valves at the junction of the ureters and the bladder

A major modifiable risk factor for nephrolithiasis is: positive family history. dehydration. smoking. drinking alcohol.

dehydration

Problems associated with a lower urinary tract obstruction include all of the following except: urinary retention. flank pain. increased voiding frequency. intermittent urinary stream.

flank pain

Intestinal perforation is a potential complication of Crohn disease because the lesions: are scattered throughout the ileum and colon. involve all layers of the bowel wall. are caused by autoimmune destruction. are inflammatory in nature.

involve all layers of the bowel wall

In hepatocellular failure, blood ammonia levels increase because hepatocytes are unable to: synthesize urea. break down aldosterone. produce albumin. secrete C-reactive protein.

synthesize urea