Pathophysiology Chapter 39 Alterations of Renal and Urinary Tract Function

Chapter 39: Alterations of Renal and Urinary Tract Function

MULTIPLE CHOICE

1.            How does progressive nephron injury affect angiotensin II activity?

a.            Angiotensin II activity is decreased.

b.            Angiotensin II activity is elevated.

c.             Angiotensin II activity is totally suppressed.

d.            Angiotensin II activity is not affected.

2.            A patient has been diagnosed with a renal stone. Based on knowledge of common stone types, what self-care measure does the healthcare professional plan to teach the patient when stone analysis has returned?

a.            Increase water intake.

b.            Decrease soda intake.

c.             Restrict animal protein in the diet.

d.            Ingest 1000 mg of calcium a day.

3.            The student asks the professor to explain the role of pyrophosphate, potassium citrate, and magnesium in the formation of kidney stones. What response by the professor is best?

a.            They inhibit crystal growth.

b.            They stimulate the supersaturation of salt.

c.             They facilitate the precipitation of salts.

d.            They enhance crystallization of salt crystals.

 4.           Hypercalciuria is primarily attributable to which alteration?

a.            Defective renal calcium reabsorption

b.            Intestinal hyperabsorption of dietary calcium

c.             Bone demineralization caused by prolonged immobilization

d.            Hyperparathyroidism

5.            Detrusor hyperreflexia develops from neurologic disorders that originate where?

a.            Spinal cord between C2 and C4

b.            Spinal cord between S2 and S4

c.             Above the pontine micturition center

d.            Below the cauda equina

6.            A patient has overactive bladder syndrome. Which classification of drug does the healthcare professional plan to teach the patient about?

a.            ?-Adrenergic blocking medications

b.            ?-Adrenergic blocking medications

c.             Parasympathomimetic medications

d.            Anticholinesterase medications

7.            Bladder cancer is associated with the gene mutation of which gene?

a.            c-erbB2

b.            Human epidermal growth factor receptor 2 (HER2)

 c.            TP53

d.            myc

8.            A female patient has been diagnosed with an uncomplicated urinary tract infection. What self- care measure does the healthcare provider teach the patient that is specific to this type of infection?

a.            Drink at least eight glasses of water a day.

b.            Take medication if you have a fever.

c.             Rest as much as you can in the next few days.

d.            After using the bathroom, wipe from front to back.

9.            A healthcare professional is assessing a patient who could have either pyelonephritis or cystitis. Which differentiating sign would assist the professional in making this diagnosis?

a.            Difficulty starting the stream of urine

b.            Spasmodic pain that radiates to the groin

c.             Increased glomerular filtration rate

d.            Urinalysis confirmation of white blood cell casts

10.          An 85-year-old person has a urinary tract infection. What clinical manifestation does the healthcare professional expect to see in this person?

a.            Confusion and poorly localized abdominal discomfort

b.            Dysuria, frequency, and suprapubic pain

c.             Hematuria and flank pain

d.            Pyuria, urgency, and frequency

11.          Pyelonephritis is usually caused by which type of organism?

a.            Bacteria

b.            Fungi

c.             Viruses

d.            Parasites

12.          Which abnormal laboratory value is found in glomerular disorders?

a.            Elevated creatinine concentration

b.            Low blood urea nitrogen (BUN)

c.             Elevated immunoglobulin A (IgA)

d.            Low serum complement

13.          Which glomerular lesion is characterized by thickening of the glomerular capillary wall with immune deposition of immunoglobulin G (IgG) and C3?

a.            Proliferative

b.            Membranous

c.             Mesangial

d.            Crescentic

14.          Goodpasture syndrome is an example of which of these?

a.            Antiglomerular basement membrane disease

 b.           Acute glomerulonephritis

c.             Chronic glomerulonephritis

d.            Immunoglobulin A (IgA) nephropathy

15.          A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. What diagnostic test or treatment regime does the healthcare professional educate the patient on?

a.            Intravenous pyelogram

b.            Oral antibiotics

c.             Renal biopsy

d.            Cyclophosphamide

16.          Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder?

a.            Nephrotic syndrome

b.            Acute glomerulonephritis

c.             Chronic glomerulonephritis

d.            Pyelonephritis

17.          A patient who has a history of mildly decreased renal function is admitted to the hospital for IV antibiotics. Which antibiotics would the healthcare professional avoid in this patient?

a.            Penicillin and ampicillin

b.            Vancomycin and bacitracin

c.             Gentamicin and tobramycin

d.            Cefazolin and cefepime

18.          Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?

a.            Urine sodium >30 mEq/L

b.            Urine osmolality >500 mOsm

c.             Fractional excretion of sodium (FENa) <1%

d.            Urine sediment has no cells, some hyaline casts

19.          How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?

a.            Glucose has an osmotic effect, which attracts water and sodium, resulting in more

dilute blood and a lower potassium concentration.

b.            When insulin transports glucose into the cell, it also carries potassium with it.

c.             Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell.

d.            Increasing insulin causes ketoacidosis, which causes potassium to move into the cell in exchange for hydrogen.

20.          Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue?

a.            Nervous system

b.            Kidneys

c.             Muscle

d.            Liver

21.          A professor has taught a student about skeletal alterations seen in chronic kidney disease. Which statement by the student indicates the professor needs to give more information?

a.            Parathyroid hormone is no longer effective in maintaining serum phosphate levels.

b.            The parathyroid gland is no longer able to secrete sufficient parathyroid hormone.

c.             The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium, is impaired.

d.            The effectiveness of calcium and phosphate resorption from bone is impaired.

22.          A patient who has chronic kidney disease has hemoglobin of 7.2 mg/dL. What treatment does the healthcare professional prepare the patient for?

a.            Intrinsic factor

b.            Vitamin B12

c.             Vitamin D

d.            Erythropoietin

23.          When the right kidney is obstructed, how will the glomeruli and tubules in the left kidney compensate?

a.            Increase in number

b.            Increase in size

c.             Develop collateral circulation

d.            Increase speed of production

24.          What medical term is used to identify a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder?

 a.           Neurogenic bladder

b.            Obstructed bladder

c.             Necrotic bladder

d.            Retrograde bladder

MULTIPLE RESPONSE

1.            In glomerulonephritis, what damages the epithelial cells resulting in proteinuria? (Select all that apply.)

a.            Ischemia

b.            Lysosomal enzymes

c.             Compression from edema

d.            Activated complement

e.            Altered membrane permeability

2.            Which statements are true concerning struvite stones? (Select all that apply.)

a.            They are more common in women than in men.

b.            Struvite stones are associated with chronic laxative use in women.

c.             They grow large and branch into a staghorn configuration in renal pelvis and calyces.

d.            They are closely associated with urinary tract infections caused by urease-producing bacteria

e.            They are more common in men than in women.

3.            A patient has renal colic. What information about this condition does the healthcare professional give the student? (Select all that apply.)

 a.           Renal colic results in mild-to-moderate pain.

b.            Pain originates in the flank area.

c.             Renal colic indicates the presence of renal stones.

d.            Pain radiated to the groin.

e.            Renal colic indicates obstruction of the renal pelvis or proximal ureter.

4.            A patient has a lesion at the sacral segments below S1. Which conditions would the healthcare professional assess the patient for? (Select all that apply.)

a.            Frequency

b.            Urge incontinence

c.             Bladder distension

d.            Urgency

e.            Urinary retention

5.            What are considered risk factors for developing bladder and kidney cancers? (Select all that apply.)

a.            Cigarette smoking

b.            Hypertension

c.             Exposure to arsenic

d.            Below normal body weight

e.            Male gender

6.            Which renal disorders are considered causes of intrarenal kidney injury? (Select all that apply.)

a.            Acute glomerulonephritis

b.            Allograft rejection

c.             Tumors

 d.           Acute tubular necrosis (ATN)

e.            Prostatic hypertrophy

7.            Prerenal injury from poor perfusion can result from which conditions? (Select all that apply.)

a.            Bilateral ureteral obstruction

b.            Renal vasoconstriction

c.             Renal artery thrombosis

d.            Hemorrhage

e.            Hypotension