Renal Pathophysiology Practice Questions with Rationales

To treat enuresis in a young girl, her pediatrician prescribes desmopressin, an antidiuretic hormone (ADH) nasal spray, before bedtime. What is the most likely rationale for this treatment? A) It removes water from the filtrate and returns it to the vascular compartment. B) It lessens the amount of fluid entering the glomerulus. C) It leads to the production of dilute urine. D) It causes tubular cells to lose their water permeability.

Ans: A It removes water from the filtrate and returns it to the vascular compartment Feedback: ADH maintains extracellular volume by returning water to the vascular compartment. This leads to the production of concentrated urine by removing water from the tubular filtrate. In exerting its effect, ADH produces a marked increase in water permeability in tubular cells.

Which of the following substances is most likely to be reabsorbed in the tubular segments of the nephron using passive transport mechanisms? A) Water B) Sodium C) Phosphate D) Calcium

Ans: A Water Feedback: Water is passively reabsorbed across the tubular epithelial membranes, while ions like sodium, phosphate, and calcium necessitate active transport.

A 60-year-old man has been diagnosed with renal calculi after repeated episodes of excruciating flank pain in recent weeks. The man states that, "I don't know how this could happened to me, since I'm so careful about eating a healthy diet." What is the most appropriate response to the man's statement? A) "Your diet may have played a part in this, but in fact, genetics are likely primarily to blame." B)"What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved." C) "You likely don't need to change your diet, but now that you have stones in one kidney, you're at very high risk of growing them in the other kidney." D) "Your diet might be normally healthy, but high intake of normally beneficial minerals like calcium and magnesium can lead to stones."

ANS: B "What you eat can influence your risk of stone formation, but many other factors like hormones and your metabolism are involved." Feedback: Renal calculi have a complex etiology that includes diet, but also many other metabolic and endocrine factors, among others. Genetics are not identified as a contributor, and mineral intake is not likely to be the sole factor. Stone formation is normally unilateral.

A 22-year-old female with a history of intermittent flank pain, repeated UTI's, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of this diagnosis? A) UTI's coupled with an impaired immune response have caused her ADPKD. B) She has inherited a tendency for epithelial cells in her tubules to proliferate inappropriately. C) Severe hypertension and portal hypertension are likely precursors D) She has inherited undersized kidneys that are prone to calculi formation.

ANS: B She has inherited a tendency for epithelial cells in her tubules to proliferate inappropriately. Feedback: ADPKD is an inherited condition, and the etiology is thought to involve cysts arising in segments of the renal tubules from a few epithelial cells that proliferate abnormally. UTI's are consequent, not causative, of the condition. Severe hypertension and portal hypertension are more commonly associated with ARPKD than ADPKD. Kidneys are typically oversized in ADPKD, and renal calculi are not noted sequelae.

One of the most reliable predictors for worsening autosomal dominant polycystic kidney disease is A) Serum creatinine levels B) Blood urea nitrogen (BUN) level C) Urine albumin excretion (UAE) D) Urine specific gravity

ANS: C Urine albumin excretion (UAE) Feedback: Serum creatine levels have not been found to be an effective predictor marker for worsening ADPKD, but urine albumin excretion (UAE) has been determined a reliable predictor, as have increased electrolytes and hematuria.

A patient in a hospital is frustrated in the inconvenience of having to collect his urine for an entire day and night as part of an ordered 24-hour urine collection test. He asks the nurse why the test is necessary since he provided a single urine sample 2 days ago. How could the nurse best respond to the patient's question? A) "A single urine sample lets your care team determine if there are bacteria in your urine, but other tests of urine chemistry need a longer-term view." B) "Current lab tests aren't able to detect the small quantities of most substances contained in a single urine sample." C) "Only a large-term test is able to show whether your kidneys are letting sugar spill out into your urine." D) "Often why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much it is present in your urine."

ANS: D "Often why an abnormal substance shows up in urine test, a 24-hour urine collection is needed to determine exactly how much it is present in your urine." Feedback: Twenty-four-hour urine tests are often used to quantify the number of substances, such as proteins, that an individual's kidneys are spilling. Single urine samples are able to assess more parameters than just the presence of bacteria, and they are sufficient in quantity to detect numerous substances such as glucose.

The clinical nurse educator on a nephrology unit of a large, urban hospital is orientating recent nursing graduates to the unit. Which of the following teaching points about acute tubular necrosis (ATN) should the educator include in the orientation session? A) "The cardinal signs of ATN are oliguria and retention of potassium, creatine, and sulfates." B) "Ureteral and bladder outlet obstructions are often contributors to ATN." C) "Trauma, burns, and major surgery are common precursors to ATN." D) "Tubular epithelial cells are sensitive to ischemia and toxins, and damage is irreversible."

ANS:(C) "Trauma, burns, and major surgery are common precursors to ATN." Feedback: ATN is often proceeded by major surgery, burns, or trauma. Many cases of ATN are Non oliguric, and obstructions that are postrenal in nature are not common causes of ATN. Damage to tubular epithelial cells is not necessarily irreversible.

A hospital client with a diagnosis of chronic renal failure has orders for measurement of her serum electrolyte levels three times per week. Which of the following statements best captures the relationship between renal failure and sodium regulation? A) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. B) Renal clients often require a sodium-restricted diet to minimize the excretion load on remaining nephrons. C) Clients with renal failure often maintain high sodium levels because of decreased excretion. D) Restricting sodium intake helps to preserve nephron function and has the additional benefit of lowering BP.

Ans: (A) Clients with advanced renal failure are prone to hyponatremia because of impaired tubular reabsorption. Feedback: The compromise ability of the tubular nephrons to reabsorb sodium predispose renal clients to low serum sodium levels. A sodium restriction is thus not normally indicated.

A 1 -year-old baby boy with renal dysplasia risks end-stage renal disease unless intervention occurs. Which of the following treatment options is his care team most likely to reject? A) Dietary restriction plus erythropoietin B) Continuous cyclic peritoneal dialysis C) Renal transplantation D) Continuous ambulatory peritoneal dialysis

Ans: (A) Dietary restriction plus erythropoietin Feedback: Renal transplantation and dialysis are recommended for children; of these, transplantation is the preferred treatment. Conservative measures are inappropriate in this age group because of the importance of fostering proper bone growth especially in the first 2 years, and appropriate cognitive development, which is at risk due to issues such as uremic encephalopathy and the effects of renal failure upon the central nervous system of the developing child.

Following the diagnosis of acute renal failure, the nurse knows that the one of the earliest manifestations of residual tubular damage is which of the following lab/diagnostic results? A) Elevated blood urea nitrogen (BUN) B) Serum creatine elevation C) Inability to concentrate urine D) Reduced glomerular filtration rate

Ans: (A) Elevated blood urea nitrogen (BUN) Feedback: Urine tests that measure urine osmolality, urine sodium concentration, and fractional excretion of sodium help differentiate prerenal azotemia, in which the reabsorptive capacity of the tubular cells is maintained, from tubular necrosis, in which these functions are lost. One of the earliest manifestations of tubular damage is the inability to concentrate urine. Conventional markers of serum creatinine and urea nitrogen, fractional secretion of sodium to assess glomerular filtration rate (GFR), and urine output do not manifest for 1 to 2 days after the acute renal failure has begun.

A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to currently occur as a result of her urinary retention? A) Hypertrophy of the bladder muscle and increased bladder wall thickness B) Decreased urine production and nitrogenous waste excretion by the kidneys C) Decompensation, bladder, stretching, and high residual urine volume D) Overflow incontinence and loss of contraction power

Ans: (A) Hypertrophy of the bladder muscle and increased bladder wall thickness Feedback: Early accompaniments to urinary retention include hypertrophy of the bladder muscle and increased thickness of the bladder wall. Renal effects are unlikely, and decompensation and loss of contraction power are most often later rather than early effects.

An 87-year-old male resident of an assisted living facility has been consistently continent of urine until the last several weeks. Which of the following actions by the care providers at the facility is the most likely priority? A) Performing a physical examination and history to determine the exact cause and character of the incontinence B) Providing client education focusing on the fact that occasional incontinence is a normal, age-related change C) Teaching the resident about protective pads, collection devices, and medications that may be effective D) Showing the resident, the correct technique for exercises to improve bladder, sphincter, and pelvic floor tone

Ans: (A) Performing a physical examination and history to determine the exact cause and character of the incontinence Feedback: The priority in the treatment of incontinence in the elderly is an acknowledgement that it is not an inevitability and that the exact causes should and most often can be identified. This identification by way of history-taking and examination would supersede the teaching about protective devices or exercises.

Which of the following phenomena contributes to the difficulties with absorption, distribution, and elimination of drugs that are associated with kidney disease? A) Reduction in plasma proteins increase the amount of drug free and decreases the amount of protein-bound drug. B) Acute tubular necrosis is associated with impaired drug reabsorption through the tubular epithelium. C) Decreased retention by the kidneys often renders normal drug dosages ineffective. D) Dialysis removes active metabolites from circulation minimizing therapeutic effect.

Ans: (A) Reduction in plasma proteins increase the amount of drug free and decreases the amount of protein-bound drug. Feedback: A decrease in plasma proteins, particularly albumin, that occurs in many persons with renal failure results in less protein-bound drug and greater amounts of free drug. Drug elimination problems do not stem as directly from impaired tubular reabsorption, decreased retention, or the process of dialysis.

Which of the following clients would be considered to have a significant risk of developing the prerenal form of acute renal failure? Select all that apply. A) A 22-year-old male who has lost large amounts of blood following a workplace injury B) a 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis C) a 79-year-old male with diagnosis of poorly controlled diabetes mellitus and heart failure D) a 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug E) a 68-year-old male with a diagnosis of benign prostate hyperplasia (BPH) (F) 80-year-old female who has been admitted for the treatment of dehydration and

Ans: (A) a 22-year-old male who has lost large amounts of blood following a workplace injury (C) a 79-year-old male with diagnoses of poorly controlled diabetes by diabetes mellitus and heart failure (F) an 80-year-old female who has been admitted to for the treatment of dehydration and malnutrition Feedback: hemorrhage, heart failure, and dehydration (hypovolemia) are all noted contributors to prerenal failure. pyelonephritis and damage from nephrotoxic drugs would more likely result in intrinsic renal failure, while BPH is post renal in nature.

Following kidney transplantation, the patient is prescribed maintenance immunosuppressive therapy consisting of Prednisone, azathioprine, and cyclosporine. Educating the patient about long term maintenance on immunosuppressive therapy should include discussions of side effects that may include: A) Cardiovascular complications B) increase risk of developing cancer C) nephrotoxicity of a newly transplanted kidney D) development of moon phase in Buffalo hump E) Ringing or buzzing of the ears

Ans: (A) cardiovascular complications (B) increase risk of developing cancer Feedback: mostly all immunosuppressed the drugs have a serious side effect such as CV complications, metabolic dysfunction, and cancer. Rarely do these medications harm the newly transplanted kidney. Distractor D list classic signs and symptoms of Cushing syndrome. Ringing or buzzing of the ears can be associated with ibuprofen intake.

While living and hiking in the Rocky Mountains, a gentleman slipped and fell. He goes to an urgent care where an x-ray was done, and some blood was drawn for a CBC. The clinic informs him that he is anemic. What may contribute to this person's anemia? Select all that apply. A) Living in a high altitude B) Tissue hypoxia C) Inability to manufacture erythropoietin D) Destruction of RBCs caused by natural killer cells E) Dehydration

Ans: (A) living in a high altitude (B) Tissue hypoxia (C) Inability to manufacture erythropoietin Feedback: the synthesis of erythropoietin is stimulated by tissue hypoxia, which may be brought about by anemia, residing at high altitudes, or impaired oxygenation of tissue due to cardiac or pulmonary disease. Dehydration will cause an elevated level of RBCs.

A pediatric unit will be receiving an 8-day old infant with a suspected congenital renal disorder. Which of the following renal abnormalities could be the possible cause? Select all that apply. A) One of the infants' kidneys may have failed to develop normally B) the kidneys may be misshapen and have cysts present C) the upper or lower poles of the kit two kidneys may be fused D) renal cell carcinoma may be present E) urine -field dilation of renal pelvis associated with atrophy of the kidney may be present

Ans: (A) one of the infants' kidneys may have failed to develop normally (B) the kidneys may be misshapen and have cysts present (C) the upper or lower poles of the two kidneys may be fused Feedback: renal hypoplasia, cystic dysplasia, and horseshoe kidney are more common diagnosis in infants. Renal cell carcinoma is not a congenital condition or one that often manifests in infancy. Urine filled dilation of renal pelvis associated with atrophy of the kidney is a description of hydronephrosis.

A client has been diagnosed with having calcium oxalate kidney stones following intravenous pyelography. Which of the following teaching points about the treatment of the health problem are justifiable? Select all that apply. A) You may need to cut out cocoa, chocolate, and some nuts from your diet. B) It's important that you avoid high calcium foods like milk, cheese, and yogurt. C) We will come up with a plan to safely limit your fluid intake over the next few weeks. D) Extracorporeal shockwave lithotripsy treatment may be used to fragment larger stones. E) Most likely your stones can be dissolved by medication over the next several days.

Ans: (A) you may need to cut out cocoa, chocolate, and some nuts from your diet. (D) Extracorporeal shockwave lithotripsy treatment may be used to fragment larger stones. Feedback: individuals with calcium oxalate stones often need to avoid high oxalate foods like nuts, cocoa, and chocolate. Extracorporeal shockwave lithotripsy treatment maybe uses to fragment larger renal calculi. It would not be necessary to avoid calcium intake, and fluid intake should encourage not, curbed. Medications can reduce the potential for stone formation but are not a common treatment modality.

A nurse is collecting a urine specimen prior to measuring the albumin level in a client urine. A colleague questions the rationale for the test, stating, "I thought albumin was related to liver function, not kidney function." How can the nurse best respond to this statement? A) "Urine should normally be free of any proteins, and albumin is one of the more common proteins to be excreted in chronic renal failure." B) "Urine albumin levels are useful for diagnosing diabetic kidney disease'" C) "A urine dipstick test will tell us exactly how much albumin is being spilled by the client's kidneys'" D) "A urine test for albumin allows us to estimate the client's GFR quite accurately."

Ans: (B) "Urine albumin levels are useful for diagnosing diabetic kidney disease'" Feedback: In client's, albumin tests are useful adjunctive test of nephron injury and repair. Urine is not normally completely free of proteins, and urine dipstick does not allow for quantification of how much albumin is in a sample. Albumin tests do not allow for an accurate indirect indicator of GRF.

A frantic mother brings her young child into the ER. She states that during the evening bath, she noticed a large mass in her child's abdomen. After diagnostic testing, the pediatrician tells the parents that their child has Wilms tumor, stage IV. After the doctor leaves the room, the parents ask the nurse, "What does this mean?" The nurse will respond, "Your child ('s) A) "has cancer in his stomach." B) "has cancer in the kidney that has spread most likely to his lungs." C) "will need to undergo surgery to remove both kidneys and then go on dialysis." D) "tumor can be easily treated with chemotherapy. We will start this soon."

Ans: (B) "has cancer in the kidney that has spread most likely to his lungs." Feedback: Wilms tumor usually is a solitary mass that occurs in any part of the kidney. It usually is sharply demarcated and variably encapsulated. Stage IV means the tumors have undergone hematogenous metastasis, most commonly involving the lung. Treatment involves surgery, chemotherapy, and sometimes radiation therapy. Long-term survival is rate are good (90%) for stages I and III.

Which of the following clinical findings among older adults is most unlikely to warrant further investigation and possible treatment? A) An 81 -year-old male's serum creatinine level has increased sharply since his last blood work. B) A 78 -year-old female's GFR has been steadily declining over several years. C) A 90 -year-old female's blood urea nitrogen (BUN) is rising. D) An 80 -year-old male's whose urine dipstick reveals protein is present.

Ans: (B) A 78 -year-old female's GFR has been steadily declining over several years. Feedback: A gradual decrease in GFR is considered a normal age-related change. Increased creatinine or BUN would warrant follow-up, as would the presence in a client's urine.

Which of the following client's diagnostic blood work is most suggestive of chronic kidney disease (CKD)? A) A client with high pH; low levels of calcium; and low levels of phosphate B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels C) A client with low potassium levels; low calcitriol levels; and increased PTH levels

Ans: (B) A client with low vitamin D levels; low calcitriol levels; and elevated parathyroid hormone (PTH) levels. Feedback: CKD is associated with low vitamin D and calcitriol levels, which induces increased PTH production. CKD is also associated with acidosis (low pH), high levels of phosphate, and hyperkalemia.

A dialysis technician is providing care for a client with chronic renal failure. The technician would recognize which of the following characteristics of healthy kidneys? A) The kidneys are contained within the peritoneal cavity. B) Blood vessels, nerves, and ureters all connect with the kidney at the hilus. C) The medulla of the kidney contains the glomeruli. D) Each kidney consists of lobes, with each lobe compromised to nephrons. E) Each nephron contains several hundred glomeruli that perform filtration.

Ans: (B) Blood vessels, nerves, and ureters all connect with the kidney at the hilus. (D) Each kidney consists of lobes, with each lobe compromise to nephrons. Feedback: The hilus is the point of nerve and blood input and urine output for each kidney, and each kidney is composed of up to 18 lobes. The kidneys are outside the peritoneal cavity, and glomeruli exists in the outer cortex. Each nephron contains just one glomerulus.

Which of the following medications would the nurse anticipate being prescribed for the renal failure patient who has hyperphosphatemia? A) Vitamin D (calcitriol) B) Calcium carbonate C) Levothyroxine (Synthroid) D) Sensi par (Cinacalcet)

Ans: (B) Calcium carbonate Feedback: Phosphate-bindidng antacids (aluminum salts, calcium carbonate, or calcium acetate) may be prescribed to decrease the absorption of phosphate from the GI tract.

Which of the following statements about mesangial cells within the glomerulus is accurate? Select all that apply. A) Mesangial cells cover the entire amount of endothelial cells contained within the capillaries. B) Have phagocytic properties that remove macromolecular materials. C) Exhibit vasodilator properties to assist with increase in blood flow in times of stress D) Enlarged (hyperplasia) in response to glomerular diseases. E) Are coiled and drain Bowman capsule.

Ans: (B) Have phagocytic properties that remove macromolecular materials. (D) Enlarge (hyperplasia) in response to glomerular diseases. Feedback: Mesangial cells possess phagocytic properties and remove macromolecular materials that enter the interpapillary spaces. Mesangial cells also exhibit contractile properties in response to neurohumoral substances and are thought to contribute to the regulation of blood flow through the glomerulus. Mesangial hyperplasia and increased mesangial matrix occur in a number of glomerular diseases. The nephron tubule, called the proximal convoluted tubule, is coiled and drains the Bowman capsule.

Which of the following data would a clinician consider as most indicative of acute renal failure? A) Alterations in blood pH; peripheral edema B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) C) Decreased serum creatinine and blood urea nitrogen (BUN), decreased potassium and calcium levels D) Decreased urine output; hematuria; increased GFR

Ans: (B) Increased nitrogenous waste levels; decreased glomerular filtration rate (GFR) Feedback: The hallmark of acute renal injury is azotemia, and accumulation of nitrogenous wastes such as creatinine, urea nitrogen, and uric acid, plus a decrease in the GFR of the kidneys. While pH alterations, edema, electrolyte imbalances, and decreased urine output may accompany acute renal failure, they are all potentially attributable to other pathologies. Creatine; GFR; and BUN would unlikely rise during renal failure.

A 55 -year-old man has made an appointment to see his family physician because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man's mostly likely diagnosis and possible underlying pathophysiology problem? A) Stress incontinence due to damage to CNS inhibitory pathways B) Overactive bladder that may result from both neurogenic and myogenic sources C) Overactive bladder due to intravesical pressure exceeding urethral pressure D) Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra

Ans: (B) Overactive bladder that may result from both neurogenic and myogenic sources Feedback: The man's complaints are typical of overactive bladder, a condition that can result from the interaction of both nervous control of bladder emptying and the muscles of the bladder itself. His symptoms are not characteristic of stress incontinence, and when intravesical pressure exceeds, urethral pressure overflow incontinence results. The angle between the bladder and the posterior proximal urethra is more commonly a factor in the continence of females.

A 51-year-old woman diagnosed with cerebrovascular accident (CVA) 5 months prior is destressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the fact that would underlie the nurse's response to the client? A) Neurological diseases like MS often result in flaccid bladder dysfunction. B) She may be unable to sense her bladder filling as a result of her MS. C) Lesions to the basal ganglia or extrapyramidal tract associated with MS inhibit detrusor contraction. D) Pathological reductions in bladder volume brought on my MS necessitate frequent micturition.

Ans: (B) She may be unable to sense her bladder filling as a result of her MS. Feedback: MS may result in neurogenic bladder characterized by an inability to sense filling and consequence incontinence. She is not demonstrating the signs of flaccid bladder, and lesions to the basal ganglia or extrapyramidal tract are associated with Parkinson disease, not MS. Her disease is unlikely to directly reduce bladder volume.

During male ejaculation, which of the following statements addresses why sperm is not normally seen inside the bladder? A) The parasympathetic nervous system keeps the seminal fluid inside the urethra. B) The musculature of the trigone area, bladder neck, and prostatic urethra contracts at the same time. C) With ejaculation, the male expels some urine along with the seminal fluid to wash any extra sperm out of the bladder. D) The detrusor muscle relaxes allowing for the closing of the sphincter at the base of the bladder.

Ans: (B) The musculature of the trigone area, bladder neck, and prostatic urethra contracts at the same time. Feedback: During ejaculation, which is mediated by the SNS, the musculature of the trigone area and that of the bladder neck and prostatic urethra contracts and prevents the backflow of seminal fluid into the bladder

Which of the following patients scheduled for interventional radiology procedure requiring administration of radiocontrast dye would be considered at high risk for nephrotoxicity? Select all that apply. A) A 14-year-old with a severe abdominal pain B) a 25-year-old with a history of glomerular nephritis who was complaining of severe flank pain C) a 67-year-old diabetic undergoing diagnostic testing for new onset proteinuria D) a 45-year-old with elevated liver enzymes possibly due to fatty liver cirrhosis E) a 53-year-old male undergoing biopsy for a suspicious spot on his chest X-ray

Ans: (B) a 25-year-old with a history of glomerular nephritis who was complaining of severe flank pain (C)a 67-year-old diabetic undergoing diagnostic testing for new onset proteinuria Feedback: Radiocontrast media induced nephrotoxicity is thought to result from direct tubular toxicity and renal ischemia. The risk for renal damage caused by radiocontrast media is greatest in older adults and those with preexisting kidney disease, volume depletion, diabetes mellitus, and recent exposure to other nephrotoxic agents.

A nurse has noted the high incidence of urinary tract obstructions of a variety of ideologies. Which of the following individuals are at risk of developing urinary obstructions? Select all that apply. A) A 43-year-old male with an acid base imbalance secondary to malnutrition B) a 29-year-old female, pregnant for the first time C) a 69-year-old female with anemia secondary to insufficient erythropoietin production D) a 70-year-old male with benign prostate hyperplasia (BPH) E) a 58-year-old male with renal calculi F) a 28-year-old male with a neurogenic bladder secondary to spinal cord injury

Ans: (B) a 29-year-old female, pregnant for the first time (D) a 70-year-old male with B9 prostate hyperplasia (BPH) (E) a 58-year-old male with renal calculi (F) a 28-year-old male with a neurogenic bladder secondary to spinal cord injury Feedback: pregnancy, BPH, renal calculi, and neurogenic bladder are all identified contributors to urinary obstructions. Acid base imbalances and impaired erythropoietin production are health problems with renal involvement but are less likely to contribute to urinary obstruction.

Which of the following individuals are likely to display identified risk factors for the development of lower urinary tract obstruction? A) A 32-year-old woman who had a healthy delivery of her third child four months ago B) a 68-year-old man who has been diagnosed with benign prostate hyperplasia (BPH) C) a 55-year-old man with diabetes who is receiving diuretic medication for the treatment of hypertension D) a 30-year-old woman who has been diagnosed with gonorrhea E) a 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic Constipation F) a 20-year-old man who has spinal bifida and consequently impaired mobility

Ans: (B) a 68-year-old man who has been diagnosed with B9 prostate hyperplasia (BPH) (D) a 30-year-old woman who has been diagnosed with gonorrhea (E) a 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic Constipation (F) a 20-year-old man who has spina bifida and consequent impaired mobility Feedback: BPH frequently obstructs the urethra, while sexually transmitted diseases, bowel obstructions, and spina bifida are also associated with physical blockages of the lower urinary tract. Postpartum women and individuals receiving diuretics would be more likely to be at risk for incontinence rather than urinary retention.

During a family picnic, a relative of a nurse asks what he should do if there is blood in his urine and some pain in his lower abdomen. The best advice the nurse could give this family member would be for him to A) go to the emergency room right away. B) get an appointment with his family doctor. C) wait and see if it goes away without treatment. D) increase his intake of cranberry juice and other fluids.

Ans: (B) get an appointment with his family doctor. Feedback: There are many cases of blood in the urine (infection, kidney stones, cancer, etc.). Kidney cancer can be a silent disorder with symptoms occurring late into the disease process. Any blood in the urine should be referred to the physician for further testing (ultrasound, CT scan, MRI, etc.).

Which of the following lab results would be associated with abnormalities in kidney function? Select all that apply. A) And absent of protein in a urine sample B) increase creatinine levels C) urine gravity of 1.038 and normal serum creatinine levels D) Decreased blood urea nitrogen (BUN) level E) detectable levels of glucose in a urine sample F) elevated cystatin-C level

Ans: (B) increase creatinine levels (E) detectable levels of glucose in a urine sample (F) elevated cystatin-C level. Feedback: increased creatinine and BUN are associated with abnormalities in renal function, as is the presence of glucose in a urine sample. Urine samples normally lack protein and have a specific gravity of 1.038 to 1.040. An elevated bun coupled with normal creatinine is likely not attributable to impaired kidney function.

A 9-year-old boy has been diagnosed with the nephrotic syndrome. Place the following stages in the development of his health problem in ascending order. Use all the options. A) Hypoalbuminemia B) Increase glomerular membrane permeability C) decreased colloidal osmotic pressure D) protein escape from the plasma to the glomerular filtrate E) accumulation of fluid in the interstitial tissue (edema)

Ans: (B) increase glomerular membrane permeability (D) protein escapes from the plasma to the glomerular filtrate (A) Hypoalbuminemia (C) decreased colloidal osmotic pressure (E) accumulation of fluid in the interstitial tissue (edema) Feedback: the pathophysiology of the nephrotic syndrome involves damaged glomeruli becoming increasingly permeable to protein, allowing more protein into the glomerular filtrate. Massive proteinuria results, leading to hypoalbuminemia. generalized edema, which is the hallmark of nephrotic syndrome, result from the loss of colloidal osmotic pressure of the blood with subsequent accumulation of fluid in the interstitial tissues.

A 24 -year-old man is currently in a rehabilitation facility following a spinal cord injury at level T2. He is discussing his long-term options for continence management. Which of the following statements by the client demonstrates he has a clear understanding of the issue? A) "Self-catheterization can limit the recovery of my neural pathways that control my voiding if I do it too often." B) "It's critical that intermittent catheterization be performed using sterile technique." C) "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications." D) " An indwelling urethral catheter is the option that best minimizes my chance of a urinary infection."

Ans: (C) "An indwelling catheter certainly would work well, but it comes with a number of risks and possible complications." Feedback: Indwelling catheters carry a risk of infections and kidney stones. Catheterization does not influence the activity of the neural pathways, and intermittent catheterization can be performing using clean technique. Indwelling urethral catheters carry a high risk of urinary tract infections.

A new educator is performing client education with a 51 -year-old man who has been recently diagnosed with chronic kidney disease. Which of the following statements by the client would the nurse most likely want to correct or clarify? A) "I'll be prone to anemia since I'm not producing as much of the hormone that causes my bones to produce red blood cells." B) "My heart rate might go up because of my kidney disease, and my blood might be a lot thinner than it should be." C) "My kidney problems increase my chances of developing high BP or diabetes." D) "I'll have a risk of either bleeding too easily or possibly clotting too quickly, though dialysis can help minimize theses effects."

Ans: (C) "My kidney problems increase my chances of developing high BP or diabetes." Feedback: While high BP can be causative of, or consequence to, renal failure, diabetes is normally a result of existing CKD. Persons with renal failure are indeed prone to anemia, increased heart rate, decreased blood viscosity, and coagulopathies. The risk of bleeding with thrombotic disorders can be particularly mitigated by dialysis.

A family physician is providing care for a 61-year-old obese male who has a history of diabetes and hypertension. Blood work had indicated that the man has a GFR of 51 mL/minute with elevated serum creatine levels. Which of the following statements will the physician most likely provide the client in light of these results? A) "We will regularly monitor your kidney function, but most likely your kidneys will be able to compensate on their own and intervention is not required." B) "You likely have chronic kidney disease, and there may be urine in your blood until it is controlled." C) "Your kidney failure disease has likely been caused by your diabetes and high BP." D) "You're in kidney failure, and I'll be starting dialysis treatment immediately."

Ans: (C) "Your kidney failure disease has likely been caused by your diabetes and high BP." Feedback: Diabetes and high BP are conditions that can cause chronic kidney disease (CKD). While the kidneys do have a remarkable ability to compensate for impaired function, this does not mean that treatment would not be undertaken. Hematuria is not a common manifestation of od CKD, and the client's GFR for 51 mL/minute does not indicate kidney failure or the need for dialysis

A 63-year-old woman has visited a physician because she has been intermittently passing blood-tinge urine over the last several weeks, and cytology has confirmed a diagnosis of invasive bladder cancer. Which of the following statements by the physician is most accurate? A) "There are new and highly effective chemotherapy regimens that we will investigate." B) "Fortunately, bladder cancer has a very low mortality rate, and successful treatment is nearly always possible." C) "it's likely that you'll need surgery, possibly a procedure called a cystectomy." D) "Unfortunately, there are nearly no treatment options for this type of cancer, but we will focus on addressing your symptoms."

Ans: (C) "it's likely that you'll need surgery, possibly a procedure called a cystectomy." Feedback: Surgical interventions are common in the treatment of bladder cancer. Effective chemotherapeutic regimens are not yet available, though there are certainly treatment options. The mortality rate of bladder cancer is high, at around 25%.

To maintain hematocrit levels in people with kidney failure, the nurse should be prepared to A) Arrange for frequent blood transfusions is an outpatient procedure clinic B) Administer iron dextran intravenously C) Administer a subcutaneous injection of recombinant human erythropoietin (rhEPO). D) Administer prenatal vitamins twice a day.

Ans: (C) Administer a subcutaneous injection of recombinant human erythropoietin (rhEPO). Feedback: Recombinant human erythropoietin (rhEPO) helps maintain hematocrit levels in people with kidney failure. Secondary benefits include improvement in appetite, energy level, sexual function, skin color, and hair and nail growth, and reduced cold intolerance. Blood transfusion is a treatment if symptomatic with low hemoglobin; however, they try to prevent this by giving EPO or IV iron dextran if there is severe iron deficiency anemia. Prenatal vitamins are high in vitamins but not helpful to renal failure patients.

A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her family doctor with complaints of a recent onset of urinary retention. She reveals to her physician that she has been taking nonprescription cold medications over the above the suggested dose for the past 2weeks. Which of the following phenomena will her physician most likely suspect is contributing to her urinary retention? A) Cholinergic actions of the cold medications are triggering internal and external sphincter contraction. B) Antihistamine effects inhibit communication between the pons and the thoracolumbar cord. C) The anticholinergic effects of the cold medications are impairing normal bladder function. D) Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying

Ans: (C) Antihistamine effects inhibit communication between the pons and the thoracolumbar cord. Feedback: Many over the counter cold medicine have an anticholinergic effect that interfere with normal bladder emptying. These effects on micturition are not a result of cholinergic actions or miscommunication between the pontine micturition center and the spinal cord. Stimulation of the parasympathetic nervous system would tend to increase rather than decrease bladder emptying.

When explaining about the passage of urine to a group for nursing students, the clinic nurse asks them which muscle is primarily responsible for micturition? Their correct reply is the A) Urinary vesicle B) Trigone C) Detrusor D) External sphincter

Ans: (C) Detrusor Feedback: The detrusor muscle is the muscle of micturition. When it contracts, urine is expelled from the bladder. External sphincter is a circular muscle that surrounds the urethra distal to the base of the bladder and can stop micturition when it is occurring. Trigone is a smooth triangular area that is bounded by the ureters and urethra. Urinary vesicle is another name for the bladder.

The nurse assessing a renal patient for encephalopathy caused by high uremic levels may observe which of the following clinical manifestations? A) Severe chest pain with pericardial friction rub on auscultation B) Stiff immobile joints and contractures C) Loss of recent memory and inattention D) Pruritis with yellow hue to skin tone

Ans: (C) Loss of recent memory and inattention Feedback: Reduction in alertness and awareness are the earliest and most significant indications of uremic encephalopathy. These often are followed by an inability to fix attention, loss of recent memory, and perceptual errors in identifying people and objects. Answer choice A refers to pericarditis; answer choice B refers to arthritis; answer choice D refers to liver involvement.

A 35-year-old female ultramarathon runner is admitted to the hospital following a daylong, 50-mile race because her urinary volume is drastically decreased, and her urine is dark red. Test indicates that she is in the initiating phase of acute tubular necrosis. Why is her urine red? A) Hematuria B) Hemoglobinuria C) Myoglobinuria D) Kidney bleeding

Ans: (C) Myoglobinuria Feedback: Myoglobinuria, which can cause acute tubular necrosis via intratubular obstruction, involves the teaching of myoglobin from the skeletal muscle into the urine, bypassing the usual filtration by the glomerulus. Excess exercise and muscle trauma can contribute to this. While both hemoglobinuria and myoglobinuria discolor the urine, hemoglobinuria results from hemolysis following a reaction to a blood transfusion, whereas myoglobinuria involves muscle damage.

When teaching a community education class about the seven warning signs of cancer, the nurse will note that most common sign of bladder cancer is A) Inability to empty the bladder fully B) Colic spasms of the ureters C) Painless bloody urine D) Passage of large clots after voiding

Ans: (C) Painless bloody urine Feedback: The most common sign of bladder cancer is painless hematuria. Gross hematuria is a presenting sign in the majority of people with the disease, and microscopic hematuria is present in most others. Answer choice A refers to flaccid bladder; answer choice B refers to kidney stones; answer choice D refers to clots that are usually seen after surgery such as TURP were bladder irrigation is called for to prevent the clots from blocking urine output.

A patient who has suffered a spinal cord injury at C4 is experiencing a sudden change in condition. His BP is 181/101; heart rate is 45; and is profusely sweating and complaining of "not feeling right." The nurse should A) Call a "Code Blue." B) Page a physician stat. and ask for antihypertensive medication. C) Palpate his bladder for overdistention. D) Place his bed flat and elevate the foot of the bed

Ans: (C) Palpate his bladder for overdistention. Feedback: The most common causes of spastic bladder dysfunction are spinal cord lesions such as spinal cord injury, herniated intervertebral disk, vascular lesions, tumors, and myelitis. Because the injury interrupts CNS control of the sympathetic reflexes in the spinal cord, severe hypertension, bradycardia, and sweating can be triggered by insertion of a catheter or mild overdistention of the bladder. The patient does not qualify for a Code Blue since he still has a pulse and is breathing. Antihypertensive medications are not necessary if the bladder is emptied. Placing him flat with the foot of the bed elevated will not help this situation.

Because they strengthen the pelvic floor muscles, Kegel exercises are most likely to help: A) Overflow incontinence B) Urge incontinence C) Stress incontinence D) Mixed incontinence

Ans: (C) Stress incontinence Feedback: Stress incontinence is commonly caused by weak pelvic floor muscles, which allow the angle between the bladder and the posterior proximal urethra to change so that the bladder and urethra are positioned for voiding when some activity increases intra-abdominal pressure. Overflow incontinence results when the bladder becomes distended and detrusor activity is absent. Urge incontinence is probably related to CNS control of bladder sensation and emptying or to the smooth muscle of the bladder. Mixed incontinence, a combination of stress and urge incontinence, probably has more than one cause.

A 42-year-old male has been diagnosed with renal failure secondary to diabetes mellitus and is scheduled to begin dialysis soon. Which of the following statements by the client reflects an accurate understanding of the process of hemodialysis? A) "It's stressful knowing that committing to dialysis means I can't qualify for a kidney transplant." B) "I know I'll have to go to a hospital or dialysis center for treatment." C) "Changing my schedule to accommodate 3 to 4 hours of hemodialysis each day will be difficult." D) "I won't be able to go about my normal routine during treatment."

Ans: (D) "I won't be able to go about my normal routine during treatment." Feedback: Hemodialysis require the client to remain connected to dialysis machinery, whereas peritoneal dialysis allows for activity during treatment. Dialysis does not disqualify an individual from receiving a transplant. Dialysis does not require attendance at a dialysis center, and patients can be taught to perform the dialysis in their home with a family member in attendance. Hemodialysis is normally conducted three times weekly, not once per day.

A diabetes education nurse is teaching a group of recently diagnosed diabetics about the potential genitourinary complications of diabetes and the consequent importance of vigilant blood glucose control. Which of the following teaching points best convey an aspect of bladder dysfunction and diabetes mellitus? A) " People with diabetes are highly susceptible to urethral obstructions, and these can heal more slowly and cause more damage than in people without diabetes." B) "High blood sugar results in a high glucose level in your urine, and this can make your bladder muscle less able to fully empty the bladder." C) "Many people with diabetes find it necessary to live with an indwelling catheter to ensure their bladders do not become too full." D) "It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying."

Ans: (D) "It's important for you to empty your bladder frequently because diabetes carries risks of kidney damage that can be exacerbated by incomplete bladder emptying." Feedback: Diabetics are vulnerable to peripheral neuropathies that can be somewhat mitigated by regular voiding; they also especially vulnerable to renal damage from high blood sugars, a situation that is worsened when accompanied by incomplete bladder emptying. Urethral obstructions are not noted complications of diabetes, and indwelling catheter placement is not normally necessary. High blood sugars do not necessarily yield high-glucose urine, and the bladder deficits associated with diabetes are neurological in nature rather than a result of particular urine chemistry.

When explaining a cystometry test to measure bladder pressure during filling and voiding in a normal adult, the nurse informs the nursing students that the normal capacity when adults have a desire to void is A) 100 to 150 mL B) 200 to 250 mL C) 300 to 399 mL D) 400 to 500 mL

Ans: (D) 400 to 500 mL Feedback: The desire to void occurs when the bladder is full (normally capacity is approximately 400 to 500 mL). At this point, a definite sensation of fullness occurs; the pressure rises sharply to 40 to 100 cm H2O; and voiding occurs around the catheter.

A middle-aged man with diabetes reports that he must strain to urinate and that his urine stream is weak and dribbling. He also reports feeling that his bladder never really empties. The nurse knows that all of his complaints are likely caused by which of the following medical diagnoses? A) Detrusor muscle areflexia B) Detrusor-sphincter dyssynergia C) Uninhibited neurogenic bladder D) Bladder atony with dysfunction

Ans: (D) Bladder atony with dysfunction Feedback: Diabetes causes peripheral neuropathy, which can affect the sensory axons of the urinary bladder. Bladder atony with dysfunction is a frequent complication of diabetes mellitus.

A patient asks the nurse what it means when the doctor said that he had adenocarcinoma of the bladder. Reviewing the pathophysiology principles behind this type of cancer, the nurse knows A) It is a low-grade tumor that is readily cured with bladder surgery B) After resection of the cancer, the prognosis is excellent with this type of cancer cell C) That these types of cancer cells are very invasive to the tissue; therefore, the entire bladder must be removed D) This is rare but highly metastatic tumor that has a very poor prognosis

Ans: (D) This is rare but highly metastatic tumor that has a very poor prognosis Feedback: Adenocarcinoma is rare and highly metastatic. Answer choices A and B relate to urothelial carcinoma; answer choice C relates to squamous cell carcinoma.

A 4-year-old boy who has been deaf since birth and has bilateral cataracts has been brought to the ER by his mother because she noticed blood in the toilet after he last voided. Urinalysis confirms heavy microscopic hematuria as well as proteinuria. What will the health care team's initial differential diagnosis most likely be? A) Alport syndrome B) Systemic lupus erythematous glomerulonephritis C) Henoch-Schönlein purpura nephritis D) Immunoglobulin A nephropathy

Ans: A Alport syndrome Feedback: Heavy microscopic hematuria, proteinuria, and sensorineural deafness and eye disorders are characteristics of Alport syndrome. This symptomatology is less characteristics of systemic lupus erythematous glomerulonephritis, Henoch-Schönlein purpura nephritis, or immunoglobulin A nephropathy

Which of the following clients on a medical unit of a hospital is most likely to be experiencing health problems that may be attributable to kidney disease? A) An 81 -year-old female client with osteoporosis and anemia B) A 77-year-old client with urinary retention due to benign prostatic hyperplasia (BPH) C) A 55-year-old- women with a recent stroke secondary to a long-standing hypertension D) A 60 -year-old man with systemic fungal infection requiring intravenous antibiotics

Ans: A An 81 -year-old female client with osteoporosis and anemia Feedback: The kidneys play a role in both vitamin D activation and regulation of red blood cell production, deficiencies of which may result in osteoporosis and anemia, respectively. BPH, stroke, and infections are less likely to result from kidney disease.

A 73-year-old man represents to his family physician with complaints of recent urinary hesitation and eventually diagnosed with benign prostatic hyperplasia (BPH). Which of the following clinical consequences would his care provider expect prior to the resolution of his health problems? A) Hydroureter and pain B) Development of renal calculi and renal cysts C) Unilateral hydronephrosis and pain D) Develpment of glomerulonephritis or nephrotic syndrome

Ans: A Hydroureter and pain Feedback: Pain in the distention of the distal ureter would be expected manifestations of BPH. Renal calculi, cysts, glomerulonephritis, and nephrotic syndrome are unlikely to develop consequentially, and unilateral hydronephrosis is unlikely, given that the obstruction is below the level of the ureterovesical junction.

A nurse educator is orientating new nurses to a renal unit of the hospital. Which of the following teaching points should the nurse include as part of a review of normal glomerular function? A) "Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewherein the body." B) "Glomerular filtrate is very similar in composition to blood plasma found elsewherein circulation." C) "Dialation of the afferent arteriole allows more blood into the nephron and increases the glomerular filtrate rate." D) "The glomerulus is located between an arteriole and a venule that work together to regulate blood flow."

Ans: B "Glomerular filtrate is very similar in comparison to blood plasma found elsewhere circulation." Feedback: Because filtration achieves the removal of nearly all blood proteins, the glomerular filtrate is nearly identical to plasma. Nephrons require high pressure to function, and dilation decreases the glomerular filtration rate. The glomerulus is located between two arterioles.

Which of the following patients on a geriatric medical unit is most likely to require slow-releasing potassium supplements on a regular basis? A) A 90 -year-old female who is taking an aldosterone antagonist to treat pulmonary edema B) An 81 -year-old male who takes a thiazide diuretic to control his hypertension C) A 79 -year-old male with heart failure who is receiving a loop diuretic D) An 83 -year-old female who is taking an osmotic diuretic to address severe peripheral edema

Ans: B An 81 -year-old male who takes a thiazide diuretic to control his hypertension Feedback: A common side effect of thiazide diuretics is increased potassium losses in the urine, which may necessitate potassium supplementation. Aldosterone antagonists, loop diuretics, and osmotic diuretics are likely to induce hyperkalemia.

Following an automobile accident where the patient had a traumatic amputation of his lower leg and lost 40% of his blood volume, he is currently not producing any urine output. The nurse bases this phenomenon on which of the following humoral substances responsible for causing severe vasoconstriction of the renal vessels? A) Aquaporin-2 channels B) Angiotensin II and ADH C) Renin and potassium ions D) Albumin and norepinephrine

Ans: B Angiotensin II and ADH Feedback: Increased sympathetic activity causes constriction of the afferent and efferent arterioles and thus a marked decrease in renal blood flow. Intense sympathetic stimulation can produce marked decrease in renal blood flow and GFR. Humoral substances, including angiotensin II, ADH, and endothelin's, produce vasoconstriction of renal blood flow. Aquaporin-2 channels, potassium ions, and albumin do not have vasoconstriction properties.

At which of the following locations in the nephron would a health care professional first expect blood to be largely free of plasma proteins? A) Proximal convoluted tubule B) Bowman space C) Loop of Henle D) Afferent arteriole

Ans: B Bowman space Feedback: Active filtration when the whole blood enters via the afferent arterioles into the glomerular capillaries, and the blood is then filtered into the Bowman space, removing plasma proteins. The filtrate that enters the proximal convoluted tubule and the loop of Henle is already free of plasma proteins.

Which of the following pain descriptions would lead the nurse to suspect the client is experiencing ureteral colic? A) Right upper quadrant pain that worsens with deep breaths and palpation. B) Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area. C) Pain described as "fire poking in their side," pulsating with every heartbeat but decreases when in fetal position. D) Perineal pain in that increases when urinating and then lessens until the time to urinate again.

Ans: B Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area. Feedback: Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man.

A nurse in acute medical unit of a hospital has admitted a 62-year-old female from the ER who has been diagnosed with acute pyelonephritis. Which of the following statements most accurately conveys an aspect of the knowledge base that the nurse needs to perform adequate care and teaching? A) Most cases of acute pyelonephritis are attributable poorly controlled hypertension. B) Flank pain, dysuria, and nausea and vomiting are likely assessment findings. C) The infection in the kidneys is most likely a manifestation of a systemic infection D) Imaging tests are likely to reveal scarring and deformation of the renal calices and pelvis.

Ans: B Flank pain, dysuria, and nausea and vomiting are likely assessment findings Feedback: Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, vomiting. Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis.

Whie assessing a patient with urosepsis, the ICU nurse notes the patient's BP 80/54, HR 132; RR 24; and pulse oximetry 89% on 6 1pm O2. Over the last hour, the patient's urine output is 15 ml. When explaining to a new graduate nurse, the nurse will emphasize that the patient's status may relate to that A) The infection is deep inside the kidney, and it will take a long time for the antibiotics to kill the bacteria. B) The patient's sympathetic nervous system has been stimulated that has resulted in vasoconstriction of the afferent arteriole, which causes a decrease in renal blood flow. C) The glomerular filtration system gets overwhelmed in times of stress (like infections) and can become clogged with waste material from the bacteria. D) The ability to transport substances from the tubular fluid into the peritubular capillaries become impaired, which results in fluid forced out of capillaries into the glomerulus.

Ans: B The patient's sympathetic nervous system has been stimulated that has resulted in vasoconstriction of the afferent arteriole, which causes a decrease in renal blood flow. Feedback: During periods of strong sympathetic stimulations, such as shock, constriction of the afferent arteriole causes a marked decrease in renal blood flow and thus glomerular filtration pressure. Consequently, urine output can fall almost to zero.

Because the associated nephropathy is an important cause of end-stage renal failure in children and adolescents, a toddler who has had an uncomplicated bout of urinary tract infection (UTI) should still be evaluated for A) Urethrovesical reflux B) Vesicoureteral reflux C) Neurogenic bladder D) Detrusor muscle instability

Ans: B Vesicoureteral reflux Feedback: Urethrovesical reflux occurs when urine from the urethra moves into the bladder. Vesicoureteral reflux occurs when urine moves from the bladder into the ureter. Vesicoureteral reflux is the most commonly associated abnormality in UTIs. Reflux nephropathy is an important cause of end-stage renal disease in children and adolescents, children with a relatively uncomplicated first UTI may turn out to have significant reflux. Therefore, even a single documented UTI in a child requires careful diagnosis. Functional obstructions include neurogenic bladder, infrequent voiding, detrusor (bladder) muscle instability, and constipation.

A dialysis technicians providing care for a client with chronic renal failure. The technician would recognize which of the following characteristics of healthy kidneys? A) The kidneys are contained within the peritoneal cavity. B) Blood vessels, nerves, and ureters all connect with the kidneys at the hilus. C) The medulla of the kidneys contains glomeruli D) Each kidney consists of lobes, with each lobe comprised of nephrons. E) Each nephron contains several hundred glomeruli that perform filtration.

Ans: B, D (Blood vessels, nerves, and ureters all connect with the kidneys at the hilus) (Each kidney consists of lobes, with each lobe comprised of nephrons.) Feedback: The hilus is the point of nerve and blood input and urine output for each kidney, and each kidney is comprised of up to 18 lobes. The kidneys are outside the peritoneal cavity, and glomeruli exists in the outer cortex. Each nephron contains just one glomerulus.

A 24 -year-old old college student has presented to the campus medical clinic with complaints of frequent, burning urination and has, subsequent to urinalysis, been diagnosed with an acute lower urinary tract infection (UTI) caused by E. coli. What teaching will the clinician most likely provided to the student? A) "This should likely resolve itself if you drink a lot of water and especially cranberry or blueberry juice." B) "Unfortunately, the bacteria causing your infection is no longer responsive to antibiotics, but there are alternative treatments that we can use." C) "Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe." D) "This likely shows that you have sort of obstruction in your urinary system, so when that is treated your UTI will likely resolve as well."

Ans: C "Many of these bacteria are now resistant to some antibiotics, but I will take that into account when I choose which antibiotic to prescribe." Feedback: Microbial resistance to TMP-SMX antibiotics is now common in the United States, however, other specific antibiotic options do exist. Cranberry and blueberry juice are more appropriate as preventative rather than curative measures (reduces bacterial adherence to the epithelial lining of the urinary tract), and the majority of uncomplicated UTIs in young women are not the result of urinary obstructions.

A 34-year-old man has been taking up to 2400 mg of ibuprofen per day following a motor vehicle accident several months ago and consequent chronic pain. He has recently been diagnosed with chronic analgesic nephritis as a result of his high analgesic intake. The man is surprised at the diagnosis stating, "I thought that taking too many drugs hurts your liver if anything, not your kidneys." What is the most appropriate response to the man's statement? A) "Your liver does perform most of the detoxification in your body, but your kidneys can perform this role if your liver is unable to." B) "High drug intake can cause your kidneys to be very vulnerable to infections, which is likely what happened in your case." C) "Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." D) "It is very rare for someone as young as yourself to have kidney damage like this; usually only older people are vulnerable to kidney damage from drugs."

Ans: C "Your kidneys are vulnerable to damage because of how much blood flows through them and the fact that they break down many drugs." Feedback: High flow and pressure combine with the metabolic transformative of drugs make the kidneys vulnerable to drug toxicity. They do not play a backup role to the liver in the metabolism of drugs, and while structural and functional damage may occur with drug overuse, infection is less likely consequence. The elderly are particularly vulnerable to drug-related nephritis and nephropathies, but it would be incorrect to conclude that younger people are thus immune.

When explaining to a class of nursing students enrolled in pathophysiology, the instructor states, " the majority of energy used by the kidney is for A) Filtration of drugs out of the body B) Secretion of erythropoietin for production of RBCs. C) Active sodium transport mechanisms D) Removal of excess glucose from the blood

Ans: C Active sodium transport mechanisms Feedback: The bulk of energy used by the kidneys is for active sodium transport mechanisms that facilitate sodium reabsorption and cotransport of other electrolytes and substances such as glucose and amino acids.

A patient in the ICU has been diagnosed with hypovolemic shock. His BP is 88/53, heart rate 122, and respiratory rate is 26. Given these vital signs, the nurse should expect the urine output to be A) Maintained between 30 and 50 mL/hour with no sediment in the bag. B) Increased to 60+ mL/hour with dilute urine. C) Decreased below 30 mL/hour with decreased GFR. D) The patient's normal amount with dark, concentrated urine.

Ans: C Decreased below 30ml/hour with decreased GFR. Feedback: Under conditions of decreased perfusion or increased sympathetic nervous system stimulation, blood flow is redistributed away from the cortex toward the medulla. This redistribution of blood flow decreased glomerular filtration while maintaining the urine -concentrating ability of the kidneys, a factor that is important during conditions such as shock. The urine output would not increase, nor be normal.

A 62 -year-old woman with high blood pressure is to begin long-term treatment with a thiazide diuretic that she thinks she will need to take for some time. What should the nurse expect to happen to her potassium and calcium levels? A) Her potassium and calcium levels will not change. B) Her potassium and calcium levels will both go down. C) Her potassium level will drop, but her calcium level may rise. D) Her potassium level will rise, but her calcium level may drop.

Ans: C Her potassium level will drop, but her calcium level may rise. Feedback: Thiazide diuretics increase the loss of potassium in urine. Because calcium is actively reabsorbed in the distal convoluted tubule, it is likely that her calcium level will go up, especially if she takes it for a long time.

A 25-year-old Asian American man arrives in the ER in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What disease has likely caused his hematuria and how should it be treated? A) Goodpasture syndrome and will be treated with plasmapheresis and immunosuppressive therapy. B) Membranous glomerulonephritis and should be treated with corticosteroids C) Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease D) Kimmel Stiel- Wilson syndrome and should be treated with medication to control high BP.

Ans: C Immunoglobulin A nephropathy and may be advised to use omega-3 fatty acids to delay progression of disease Feedback: Immunoglobulin A (IgA) nephropathy (Buerger disease) is a glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits. It can occur at any age, but most commonly occurs with clinical onset in the second and third decades of life. It is more common in males than in females and it is the most common cause of glomerular nephritis in Asians. There is no satisfactory treatment for IgA nephropathy. Goodpasture syndrome is a form of glomerulonephritis; treatment include plasmapheresis to remove circulating anti-GBM antibodies and immunosuppressive therapy to inhibit antibody production. Membranous glomerulonephritis is the most common cause of primary nephrosis in adults, most commonly those in their 6th or 7th decade. It is treated with corticosteroids. In nodular glomerulosclerosis, also known as Kimmel Stiel- Wilson syndrome, there is nodular deposition hyaline in the mesangial portion of the glomerulus. As the sclerotic process progresses in the diffuse and nodular forms of glomerulosclerosis in many cases, early changes in glomerular function can be reversed by careful control of blood glucose levels. Control of high BP and smoking cessation are recommended as primary and secondary prevention strategies in person with diabetes

A physician who is providing care for a 71-year-old male client with a recent diagnosis of renal failure and acid-base balance is explaining some of the underlying etiology of the man's diagnoses to him and his family. Which of the following phenomena would most accurately underline the teaching that the physician provides? A) The kidney is integral to the reabsorption of hydrogen ions and maintenance of a low pH. B) Blood buffer system and respiratory control can compensate for inadequate renal control of pH. C) The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body. D) pH is kept at an optimal level through the renal secretion of bicarbonate ions in blood filtrate.

Ans: C The kidneys have the primary responsibility for eliminating excess hydrogen ions from the body. Feedback: The kidneys have the primary responsibility for maintaining body pH by eliminating excess hydrogen ions from the body, a function that blood buffer system and respiratory control are incapable of. Hydrogen ions must be eliminated, not retained, and bicarbonate must be produced as part of buffer action, not secreted.

A patient has just been diagnosed with acute glomerulonephritis. Which question should the nurse ask this client in attempting to establish a cause? A) "Do you have a history of heart failure?" B) "Have you recently had kidney stones?" C) "Have you ever been diagnosed with diabetes?" D) "Have you had any type of infection within the last 2 weeks?"

Ans: D "Have you had any type of infection within the last 2 weeks?" Feedback: Acute postinfectious glomerulonephritis usually occurs after infection with certain strains of group AB-hemolytic streptococci and is caused by deposition of immune complexes of antibody and bacterial antigens. Other organisms can also cause this infection.

Which of the following individuals is at the highest risk of developing a urinary tract infection (UTI)? A) A 60 -year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft. B) A 66 -year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension C) A 38 -year-old man with high urine output due to antidiuretic hormone insufficiency D) A 30 -year-old women with poorly controlled diabetes mellitus

Ans: D A 30 -year-old women with poorly controlled diabetes mellitus Feedback: Young women as well as persons with diabetes are at high risk of UTIs. Neither postsurgical recovery nor renal failure is necessarily a direct risk for UTI development, and high urine output would prevent decrease rather than increase in UTI risk.

Which of the following statements most accurately captures the function of the ascending loop of Henle? A) Urine is concentrated by the selective absorption of free water in the ascending limb. B) Sodium and water are reabsorbed in equal amounts, reducing filtrate quantity but maintaining osmolality C) The majority of solute and water reabsorption occurs in the ascending loop of Henle D) Impermeability to water and absorption of solutes yields a highly dilute filtrate

Ans: D Impermeability to water and absorption of solutes yields a highly dilute filtrate Feedback: The osmolality of the filtrate reaches a low of 100 mOsm/kg of water in the ascending limb as a result of its impermeability to water.

When explaining the role of the proximal tubule in terms of medication administration, the nursing instructor will emphasize that which of the following medications are bound to plasma proteins and require the proximal tubule secretion of exogenous organic compounds to help with filtration? Select all that apply A) Penicillin B) Aspirin C) Morphine sulfate D) Potassium chloride E) Sodium chloride

Ans:(A) Penicillin (B) Aspirin (C) Morphine sulfate Feedback: The proximal tubule secretes exogenous organic compounds such as penicillin, aspirin, and morphine. Many of these compounds can be bound to plasma proteins and are not freely filtered in the glomerulus. Therefore, excretion by filtration alone eliminates only a small portion of theses potentially toxic substances from the body.

Damage to the which of the following areas of a nephron would most likely result in impaired secretion and reabsorption? A) Distal tubule B) Loop of Henle C) Proximal tubule D) Collecting tubule

Ans: C Proximal tubule Feedback: Approximately two thirds of the absorption and secretion that occur in the tubular system take place in the proximal tubule.

The nurse should anticipate that a patient diagnosed with spastic bladder dysfunction may be prescribed with which of the following medications that will help decrease detrusor muscle tone and increase bladder capacity? A) Ditropan (Oxybutynin), an antimuscarinic drug B) Detrol LA (tolterodine tartrate), an antimuscarinic drug C) Uroxatral (alfuzosin), an a-adrenergic antagonist D) Flomax (tamsulosin), an a-blocker E) Bactrim (sulfamethoxazole and trimethoprim)

Ans: (A) Ditropan (Oxybutynin), and antimuscarinic drug (B) Detrol LA (tolterodine tartrate) an antimuscarinic drug Feedback: Antimuscarinic drugs, such as oxybutynin, tolterodine, and propantheline, decrease detrusor muscle tone and increase bladder capacity in people with spastic bladder dysfunction. Answer choice C and D are medication prescribed for males with BPH.