Patho Exam 3

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

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

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema

ANS: A Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema.

Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called a. tension pneumothorax. b. open pneumothorax. c. pleural effusion. d. empyema.

ANS: A Air that enters the pleural space during inspiration but is unable to exit during expiration causes a tension pneumothorax. The question does not describe open pneumothorax, pleural effusion, or empyema.

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

ANS: A 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

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. initiation of dialysis. b. fluid restriction. c. antibiotics. d. phlebotomy.

ANS: A 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.

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

ANS: A Fluid volume excess increases blood volume which increases glomerular filtration. Increased hydrostatic pressure in the Bowman's capsule, high oncotic pressure in the glomerular capillary, and obstruction of renal tubules oppose filtration

Which pulmonary function test result is consistent with a diagnosis of asthma? a. Reduced forced expiratory volume in 1 second (FEV1) b. Decreased functional residual capacity c. Increased FEV1 d. Reduced total lung volume

ANS: A Forced expiratory volumes (FEV1) decrease during asthma attacks. Functional residual capacity is not used to diagnose asthma. Reduced (not increased) FEV1 is found in asthma. Total lung volume is not used to diagnose asthma

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

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

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

ANS: A 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

Hypoventilation causes a. hypoxemia. b. respiratory alkalosis. c. increased minute ventilation. d. decreased PaCO2

ANS: A Hypoventilation causes increased PaCO2 and resultant hypoxemia. Hypoventilation does not cause increased minute ventilation. Hyperventilation causes respiratory alkalosis and decreased PaCO2.

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

ANS: A 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.

Left-sided heart failure is characterized by a. pulmonary congestion. b. decreased systemic vascular resistance. c. jugular vein distention. d. peripheral edema.

ANS: A Left-sided heart failure is characterized by pulmonary congestion and edema. Right-sided heart failure is characterized by congestion in the systemic venous system that increases systemic vascular resistance. Jugular vein distention is a classic sign of right-sided heart failure. Peripheral edema is seen in right-sided failure

All obstructive pulmonary disorders are characterized by a. resistance to airflow. b. hyperresponsiveness. c. decreased residual volumes. d. decreased lung compliance.

ANS: A Obstructive lung diseases are characterized by increased resistance to airflow. Only asthma is characterized by hyperresponsiveness. Increased residual volume is common in obstructive pulmonary disorders. Emphysema is characterized by increased lung compliance caused by a loss of alveoli and elastic tissue.

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

ANS: A 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.

Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class? a. Class I b. Class II c. Class III d. Class IV

ANS: A Patients who have structural heart disease but no signs or symptoms of heart failure are placed in Class I of the NYHA Classes. Class II patients have current or previous symptoms of heart failure. Class III patients have current or previous symptoms of heart failure, such as dyspnea or fatigue. Class IV patients have advanced structural heart disease and marked symptoms at rest.

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

ANS: B 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.

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

ANS: A 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.

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

ANS: A Proteinuria is an important sign of basement membrane dysfunction. Hematuria can be found in glomerular disorders but it is not specific to this; it can be caused by many disorders. Glycosuria is found primarily in diabetes mellitus. Urinary casts do not necessarily mean basement membrane dysfunction.

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

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

The amount of gas remaining in the lungs after a maximal expiration is called the a. residual volume. b. functional residual capacity. c. expiratory reserve volume. d. vital capacity.

ANS: A Residual volume is the amount of gas remaining in the lungs after a maximal expiration. Functional residual capacity is the amount of gas left in the lungs at the end of a normal expiration. Expiratory reserve volume is the amount of gas expired beyond tidal volume. Vital capacity is the total volume of gas that can be exhaled during maximal expiration.

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

ANS: A 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.

Most of the carbon dioxide in blood is a. transported as bicarbonate. b. transported on the hemoglobin molecule. c. transported as carbonic acid. d. dissolved in plasma

ANS: A Sixty to seventy percent of carbon dioxide in blood is transported as bicarbonate. Only 20% to 30% is carried on the hemoglobin molecule. An insignificant amount of carbon dioxide in blood is transported as carbonic acid. Only 5% to 10% is dissolved in plasma.

Activation of parasympathetic nerves to the bladder will cause a. bladder contraction. b. bladder relaxation. c. sphincter contraction. d. urine reflux.

ANS: A Stimulation of the parasympathetic nerves to the bladder will cause bladder contraction. Stimulation of the sympathetic nerves to the bladder will cause bladder relaxation and allow for storage of urine. Stimulation of the parasympathetic nerves to the bladder will cause bladder, not sphincter, contraction. Stimulation of the parasympathetic nerves to the bladder does not cause urine reflux

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

ANS: A The basement membrane is an important selectivity barrier of the glomerulus, preventing plasma proteins, RBCs, WBCs, and platelets from passing through the glomerulus. Endothelial tight junctions, epithelial fenestra, and mesangial cells are not the primary selectivity barriers for glomerular filtration.

The most common agent resulting in nephrotoxicity and subsequent acute tubular necrosis (ATN) in hospitalized patients is a. contrast media. b. antibiotics. c. cancer chemotherapy. d. recreational drugs

ANS: A The most common agent resulting in nephrotoxicity and subsequent ATN is contrast media. Contrast media, cancer chemotherapy, and recreational drugs are not the most common agents resulting in nephrotoxicity and subsequent ATN.

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

ANS: A 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 B12 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 normal post-void residual urine in the bladder is a. less than 100 mL. b. 150 to 200 mL. c. 250 to 300 mL. d. none of these; no normal residual volume is identified

ANS: A 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.

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

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

Emphysema results from destruction of alveolar walls and capillaries, which is because of a. release of proteolytic enzymes from immune cells. b. air trapping with resultant excessive alveolar pressure. c. excessive 1-antitrypsin. d. autoantibodies against pulmonary basement membrane

ANS: A The pathologic changes leading to alveolar destruction are associated with the release of proteolytic enzymes from inflammatory cells such as neutrophils and macrophages. While air trapping occurs in emphysema, the destruction of alveolar walls and capillaries is because of release of proteolytic enzymes. Lack of 1-antitrypsin can result in emphysema. Autoantibodies are not involved in destruction of alveolar walls and capillaries in emphysema

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. overflow. b. stress. c. urge. d. mixed.

ANS: A 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

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.

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

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

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

Beta-blockers are advocated in the management of heart failure because they a. increase cardiac output. b. reduce cardiac output. c. enhance sodium absorption. d. reduce blood flow to the kidneys.

ANS: B Beta-blockers are advocated in the management of heart failure to inhibit the cardiac effects of sympathetic activation. These drugs are negative inotropes and have the potential to reduce cardiac output. The goal with the use of beta-blockers in heart failure is to reduce cardiac output. Beta-blockers do not affect sodium reabsorption. Angiotensin II and aldosterone enhance sodium and water reabsorption by the kidney, contributing to an elevated blood volume.

The central chemoreceptors for respiratory control are a. located in the carotid artery. b. responsive primarily to changes in pH and CO2. c. responsive primarily to hypoxemia. d. less important than the peripheral chemoreceptors in maintaining respiration.

ANS: B Central chemoreceptors for respiratory control are responsive primarily to changes in pH and CO2. The central chemoreceptors are located in the medullary center, are responsive to pH and CO2, and are more important than the peripheral chemoreceptors in controlling respirations

Chronic bronchitis often leads to right sided heart failure because of a. ventricular hypoxia. b. increased pulmonary vascular resistance. c. left ventricular strain. d. hypervolemia.

ANS: B Chronic bronchitis often leads to cor pulmonale as a result of increased pulmonary vascular resistance when right ventricular end-diastolic pressure increases. Ventricular hypoxia, left ventricular strain, and hypervolemia do not lead to cor pulmonale.

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

ANS: B 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.

When exposed to inhaled allergens, a patient with asthma produces large quantities of a. IgG. b. IgE. c. IgA. d. IgM.

ANS: B During an allergic response, plasma cells produce large quantities of IgE. IgG, IgA, and IgM are not part of the pathophysiology of asthma.

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

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

After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is a. of unknown pathogenesis. b. associated with specific allergic triggers. c. associated with respiratory infections. d. induced by psychological factors (stress).

ANS: B Extrinsic asthma is also referred to as allergic asthma, which is triggered by antigens. The underlying pathogenesis of extrinsic asthma is an allergic in nature. Intrinsic asthma is associated with respiratory infections. Intrinsic asthma is associated with psychological factors

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

ANS: B 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 underlying mechanism which directly results in glycosuria is a. filtration of glucose from the glomerulus. b. exceeding the threshold for glucose reabsorption. c. secretion of glucose into the distal tubule. d. the mechanism is unknown.

ANS: B Glucose is normally freely filtered but then reabsorbed from the tubules into the peritubular capillaries. If the threshold for reabsorption is exceeded as in uncontrolled diabetes mellitus, glycosuria results. Glucose is freely filtered from the glomerulus; this is not the direct cause of glycosuria. Glucose is not secreted into the distal tubule. The underlying mechanism that directly results in glycosuria is exceeding the threshold for glucose reabsorption

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

ANS: B Glucose reabsorption occurs in the proximal convoluted tubule. Glucose reabsorption is not passive; a sodium-dependent protein co-transporter is required. Glucose reabsorption in the tubules is limited by the number of co-transporters; a threshold exists beyond which glycosuria will result. Glucose reabsorption occurs in the proximal convoluted tubule with the assistance of a sodium-dependent protein co-transporter.

Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells. a. aldosterone b. norepinephrine c. angiotensinogen d. renin

ANS: D When cardiac output is reduced, juxtaglomerular cells in the kidney release renin and initiate the renin-angiotensin-aldosterone cascade leading to salt and water retention by the kidney. Aldosterone is not released from juxtaglomerular cells. Norepinephrine is not released by cells within the kidney. Angiotensin is not involved in the process of cellular release within the kidneys.

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

ANS: B Hydrostatic pressure within the glomerular capillaries is the main driving force for filtration. A significant drop in blood pressure such as in shock severely reduces glomerular filtration. Oncotic pressure in the Bowman's capsule, permeability of the glomerular membrane, and solute content of the blood in the glomerular capillaries are not the main driving forces for filtration.

A patient with pure left-sided heart failure is likely to exhibit a. jugular vein distention. b. pulmonary congestion with dyspnea. c. peripheral edema. d. hepatomegaly

ANS: B Left-sided heart failure is most often associated with left ventricular infarction and systemic hypertension. The ineffective pumping of the left ventricle results in an accumulation of blood within the pulmonary circulation. As a result, pulmonary congestion with dyspnea is an expected finding. Jugular vein distention is more often associated with right-sided failure. Peripheral edema is associated with right-sided failure. Hepatomegaly is not seen in pure left-sided edema.

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

ANS: B Nephralgia is the term for pain that accompanies kidney disorders. Nephritic, nephrotic, and nephronitis are not terms for pain that accompanies kidney disorders.

Obstructive disorders are associated with a. low residual volumes. b. low expiratory flow rates. c. increased expiratory reserve volume. d. decreased total lung capacity.

ANS: B Obstructive disorders are associated with low expiratory flow rates. Obstructive disorders are associated with high residual volume. Increased expiratory reserve volume and decreased total lung capacity are not characteristic of obstructive disorders.

A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for a. pneumonia. b. pneumothorax. c. pulmonary edema. d. pulmonary embolus

ANS: B Pneumothorax leads to a tracheal shift to the side opposite the pneumothorax. Pneumonia, pulmonary edema, and pulmonary embolus do not lead to tracheal shift

A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing

ANS: B Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristic of restrictive respiratory disorder.

A restrictive respiratory disorder is characterized by a. increased total lung capacity. b. decreased residual volume. c. inspiratory wheezing. d. expiratory wheezing.

ANS: B Restrictive respiratory disorders are characterized by decreased residual volume. Restrictive respiratory disorders are not characterized by increased residual volume. Inspiratory and expiratory wheezing are not characteristic of restrictive respiratory disorder.

9. Secondary pulmonary hypertension is most often caused by a. increased pulmonary blood flow. b. increased pulmonary vascular resistance. c. increased left atrial pressure. d. decreased alveolar compliance

ANS: B Secondary pulmonary hypertension is most often caused by increased pulmonary vascular resistance. Although increased pulmonary blood flow and increased left atrial pressure can lead to secondary pulmonary hypertension, the most common cause is increased pulmonary vascular resistance. Decreased alveolar compliance does not cause pulmonary hypertension.

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

ANS: B 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 common denominator in all forms of heart failure is a. poor diastolic filling. b. reduced cardiac output. c. pulmonary edema. d. tissue ischemia

ANS: B The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure

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

ANS: B 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%.

The primary cause of infant respiratory distress syndrome is a. prematurity. b. lack of surfactant. c. maternal illegal drug use during pregnancy. d. umbilical cord compression

ANS: B The primary cause of this disorder is lack of surfactant. While premature infants may demonstrate this disorder, the actual cause is lack of surfactant. It is a syndrome seen in premature infants. Maternal illegal drug use during pregnancy and umbilical cord compression are not the primary causes of infant respiratory distress syndrome

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."

ANS: B 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

An increase in filtration of fluid from the pulmonary capillaries into the interstitium occurs with ________ pressure. a. increased capillary colloid b. increased capillary hydrostatic c. decreased capillary hydrostatic d. decreased interstitial colloid

ANS: B When capillary hydrostatic pressure exceeds capillary colloid osmotic pressure, fluid moves from the capillary to the interstitium. Increased capillary colloid pressure, decreased capillary hydrostatic pressure, or decreased interstitial colloid pressure would all prevent fluid movement out of the capillaries.

Which is indicative of a left tension pneumothorax? a. Course crackles throughout the left chest b. Tracheal deviation to the left c. Absent breath sounds on the left d. Respiratory acidosis

ANS: C A left pneumothorax results in absent breath sounds on the affected side. Crackles will not be heard because breath sounds are not present. Tracheal deviation occurs on the contralateral side. Pneumothorax results in acute respiratory alkalosis.

Asthma is categorized as a(n) a. restrictive pulmonary disorder. b. infective pulmonary disorder. c. obstructive pulmonary disorder. d. type of acute tracheobronchial obstruction.

ANS: C Asthma is an obstructive pulmonary disorder. Asthma is not a restrictive pulmonary disorder or a type of tracheobronchial obstruction. Although asthma can be associated with infection, it is not an infective pulmonary disorder

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

ANS: C Creatinine is an end product of muscle metabolism; muscle breakdown will increase the serum creatinine level. Serum creatinine is not affected by carbohydrate, fat, or fluid intake. Fluid volume deficit can increase the serum creatinine if it leads to acute renal failure

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

ANS: C 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.

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

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

Allergic (extrinsic) asthma is associated with a. hyporesponsiveness of airways. b. unknown precipitating factors. c. IgE-mediated airway inflammation. d. irreversible airway obstruction.

ANS: C Extrinsic (allergic) asthma is mediated by IgE triggers. Allergic (extrinsic) asthma involves hyperresponsiveness of the airways. Antigens are the precipitating factors. Airway obstruction is reversible

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

ANS: C 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

Hypoxic pulmonary vasoconstriction a. diverts blood to hypoxic regions. b. increases blood flow to the base of the lung. c. can lead to secondary pulmonary hypertension. d. is always detrimental to the patient

ANS: C Increased resistance to blood flow resulting from hypoxic vasoconstriction can lead to secondary pulmonary hypertension. Hypoxic pulmonary vasoconstriction diverts blood to nonhypoxic regions, diverts blood to any area of the lung needed, and is helpful in maintaining adequate oxygenation

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

ANS: C Potassium is secreted from the distal tubule and collecting ducts into the tubule lumen under the influence of aldosterone. Excess potassium is not excreted from the body by the renal system via glomerular filtration or the renal system based on the blood level of potassium, nor is it excreted from the body by the renal system based on the aldosterone level.

Increased preload of the cardiac chambers may lead to which patient symptom? a. Decreased heart rate b. Decreased respiratory rate c. Edema d. Excitability

ANS: C Preload reduces glomerular filtration resulting in fluid conservation, or edema. Increased preload may lead to an increased, not decreased, heart rate. Increased preload may lead to shortness of breath and an increased respiratory rate. Increased preload may lead to fatigue, not excitability, as the heart works harder to circulate blood

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

ANS: C Renin is released from the juxtaglomerular cells. Renin is not released from the posterior pituitary gland, liver, or macula densa cells.

Surfactant is a phospholipid that reduces a. pulmonary vascular capacitance. b. elastic recoil force. c. alveolar surface tension. d. pulmonary capillary fragility.

ANS: C Surfactant reduces alveolar surface tension. Surfactant does not reduce pulmonary vascular capacitance, elastic recoil force, or pulmonary capillary fragility.

Autonomic nervous system stimulation effects on the respiratory system include a. parasympathetic stimulation dilates airways. b. sympathetic stimulation constricts airways. c. sympathetic stimulation relaxes bronchial smooth muscle. d. the autonomic system has no effect on the respiratory system

ANS: C Sympathetic nervous system stimulation relaxes bronchial smooth muscle. Parasympathetic stimulation constricts airways. Sympathetic stimulation dilates airways. The autonomic nervous system does affect the respiratory system by relaxing the pulmonary blood vessels.

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

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

ANS: C The vasa recta are capillaries that surround the loops of Henle and collecting ducts and absorb interstitial fluid. The vasa recta do not secrete rennin or urea, nor do they reabsorb NaCl.

What problem is a patient likely to experience in end-stage renal disease? a. Hypokalemia b. Polyuria and nocturia c. Uremia d. Hematuria

ANS: C Uremia occurs in end-stage renal disease because the kidneys cannot excrete urea, the end product of protein metabolism. Hyperkalemia occurs in end-stage renal disease. Polyuria and nocturia do not occur in end-stage renal disease; the kidneys are unable to excrete urine. Hematuria does not generally occur unless another problem is causing it.

A patient being treated for acute tubular necrosis (ATN) develops mild polyuria. The nurse responds to questions about why this occurring by stating 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."

ANS: C 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.

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

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

ANS: D 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.

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

ANS: D Approximately two thirds of the water and electrolytes filtered by the kidney are reabsorbed by the proximal tubule. Two thirds of the water and electrolytes filtered by the kidney are not reabsorbed by the loop of Henle, collecting tubule, or distal tubule.

COPD leads to a barrel chest, because it causes a. pulmonary edema. b. muscle atrophy. c. prolonged inspiration. d. air trapping.

ANS: D Destruction of alveolar walls reduces lung elastic recoil, which allows airway collapse during exhalation. Air enters the alveoli during inhalation, but has difficulty escaping during exhalation. When air is trapped in the alveoli, residual volume increases, causing a barrel chest. Destruction of alveolar walls does not cause pulmonary edema, muscle atrophy, or prolonged inspiration.

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

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

ANS: D 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.

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

ANS: D 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.

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

ANS: D 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

Chronic pulmonary hypertension can eventually cause which complication? a. Pulmonary emboli b. Respiratory acidosis c. Chronic obstructive pulmonary disease d. Right heart failure

ANS: D Increased right ventricular afterload from pulmonary hypertension can lead to right heart failure, also known as cor pulmonale. Chronic pulmonary hypertension is not a risk factor for pulmonary emboli. Chronic respiratory acidosis is a common cause of pulmonary hypertension, rather than a complication of it. Chronic pulmonary hypertension does not cause chronic obstructive pulmonary disease; COPD may cause chronic pulmonary hypertension

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

ANS: D Infection by E. coli is the most common cause of acute pyelonephritis. Although urine obstruction or reflux can cause acute pyelonephritis, the most common cause is infection by E. coli. Systemic bacteremia may lead to pyelonephritis, but it is not the most common direct cause. Urethral catheterization may cause infection, which could subsequently result in acute pyelonephritis, but catheterization is not the most common direct cause

Accumulation of fluid in the pleural space is called a. an abscess. b. pleurisy. c. flail chest. d. pleural effusion

ANS: D Pleural effusion is accumulation of fluid in the pleural space. A lung abscess is a circumscribed area of suppuration and lung tissue destruction. Pleurisy is inflammation of the pleura that often manifests with pain on inspiration, fever, and chills. Flail chest is the fracture of several consecutive ribs

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

ANS: D 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

Primary pulmonary hypertension is a. more common in men. b. readily treatable. c. caused by genetic mutation. d. rapidly progressive

ANS: D Primary pulmonary hypertension is rapidly progressive. Primary pulmonary hypertension is more common in women and is not responsive to treatment. While primary pulmonary hypertension may be genetic in some individuals, the cause is unknown

Hypertrophy of the right ventricle is a compensatory response to a. aortic stenosis. b. aortic regurgitation. c. tricuspid stenosis. d. pulmonary stenosis.

ANS: D Right ventricular hypertrophy is the direct result of pulmonary disorders that increase pulmonary vascular resistance and impose a high afterload on the right ventricle. Aortic stenosis does not lead to right ventricular hypertrophy. Aortic regurgitation is not associated with right ventricular hypertrophy. Hypertrophy of the right ventricle is not a compensatory response to tricuspid stenosis.

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

ANS: D Serious renal impairment generally does not occur until 75% to 90% of the total nephrons have been damaged. The other answer options are incorrect

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

ANS: D Serum creatinine is a fairly reliable indicator of glomerular filtration as it is stable. The blood urea nitrogen level, urinary output, and serum osmolality are affected by factors that make them less reliable as indicators of glomerular filtration.

Shifts in the oxyhemoglobin dissociation curve represent the a. effect of carbonic anhydrase on the uptake of CO2. b. ability of blood to pick up more CO2 when PaO2 is low. c. amount of hydrogen in solution in the blood. d. changes in hemoglobin affinity for oxygen

ANS: D Shifts in the oxyhemoglobin dissociation curve represent the changes in hemoglobin affinity for oxygen. Shifts in the oxyhemoglobin dissociation curve do not represent the effect of carbonic anhydrase on the uptake of CO2, the ability of blood to pick up more CO2 when PaO2 is low, or the amount of hydrogen in solution in the blood.

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

ANS: D The glucose transporter in the proximal tubule may be saturated at high filtered glucose loads; glycosuria then results. A transport maximum does exist beyond which glycosuria occurs. A sodium-dependent protein co-transporter is needed. The transporter is not ATP-dependent.

The hallmark manifestation of acute respiratory distress syndrome is a. tachycardia. b. hypotension. c. frothy secretions. d. hypoxemia.

ANS: D The hallmark of acute respiratory distress syndrome is hypoxemia caused by intrapulmonary shunting of blood. Tachycardia, hypotension, and frothy secretion occur in this disorder but are not hallmark

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

ANS: D 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.

Which person is at greatest risk for developing a pulmonary embolism? a. A 25-year-old man with asthma b. A 28-year-old woman in the first trimester of a normal pregnancy c. A 42-year-old woman with a broken ankle d. A 67-year-old man with a deep vein thrombosis in the femoral vein

ANS: D The presence of deep vein thrombosis in the lower limbs is the most important risk factor for pulmonary embolism. Older age is also a risk factor. Asthma is not a specific risk factor for pulmonary embolism. The risk of developing blood clots and pulmonary emboli occurs later in pregnancy. Fractures of the pelvis or long bones can lead to fat emboli to the lung, but not fractures to small bones

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

ANS: D This many WBCs in the urine indicate urinary tract infection; 5 or more is not expected. 4.5 is a normal pH. Fewer than 5 RBCs is insignificant. 1.015 is a normal specific gravity.

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

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 peripheral chemoreceptors a. are located in the medulla oblongata. b. lead to hypoventilation when stimulated. c. respond to the arterial oxygen level. d. are unresponsive to pH and CO2 levels.

The peripheral chemoreceptors respond to reduced arterial oxygen (hypoxemia). The peripheral chemoreceptors are located in the aortic arch and carotid bodies, lead to hyperventilation when stimulated, and respond to pH and CO2 levels in addition to arterial oxygen level

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