NSG 3850 Exam 3: Pathophysiology II -
Comprehensive Practice Examination 2026
1. The nurse is caring for a client who has postinfectious acute glomerulonephritis. Which of the
following clinical manifestations should the nurse expect in this client?
a. Urinary hesitancy.
b. High glomerular filtration rate (GFR).
c. Hypertension and serum sodium of 129 mEq/L.
d. Smokey or coffee-colored urine.
Correct ANSWER: d. Smokey or coffee-colored urine.
Rationale:
Option a (Urinary hesitancy) is incorrect because urinary hesitancy is typically associated with benign
prostatic hyperplasia or urethral obstruction, not glomerulonephritis. Acute glomerulonephritis affects
the glomeruli, not the urethra or prostate.
Option b (High GFR) is incorrect because acute glomerulonephritis causes inflammation and damage to
the glomeruli, leading to decreased GFR, not increased. The filtration membrane becomes
compromised, reducing the kidney's ability to filter blood effectively.
Option c (Hypertension and serum sodium of 129 mEq/L) is partially correct regarding hypertension but
incorrect regarding sodium levels. In acute glomerulonephritis, sodium retention occurs due to
decreased GFR and activation of the renin-angiotensin-aldosterone system, leading to hypervolemia and
hypertension. Hyponatremia (129 mEq/L) is dilutional due to fluid retention, but the classic presentation
,includes hypertension with normal or slightly low sodium. However, the most characteristic finding is
hematuria.
Option d (Smokey or coffee-colored urine) is correct because postinfectious acute glomerulonephritis
causes damage to the glomerular basement membrane, allowing red blood cells to escape into the
urine. The RBCs are lysed and oxidized as they pass through the nephron, giving the urine a
characteristic smoky or coffee-colored appearance. This is the hallmark clinical manifestation of acute
glomerulonephritis.
2. The nurse is assessing edema in a client diagnosed with nephrotic syndrome. The nurse understands
that the edema is caused by
a. increased sodium loss leads to increased third spacing of fluids.
b. serum albumin is lost, oncotic pressure decreases allowing fluids to escape.
c. large glucose molecules increase and crowd out all other molecules.
d. oncotic pressure increases forcing fluids out into the interstitial spaces.
Correct ANSWER: b. serum albumin is lost, oncotic pressure decreases allowing fluids to escape.
Rationale:
Option a (Increased sodium loss) is incorrect because in nephrotic syndrome, sodium is retained, not
lost, due to the kidneys' compensatory mechanisms. Sodium retention contributes to edema, but it is
not the primary cause. The primary mechanism is loss of plasma proteins.
Option b (Serum albumin is lost, oncotic pressure decreases) is correct because nephrotic syndrome is
characterized by massive proteinuria (>3.5g/day). The glomerular membrane becomes excessively
permeable, allowing albumin to leak into the urine. This loss of albumin reduces plasma oncotic (colloid
osmotic) pressure, which normally pulls fluid from the interstitial space into the capillaries. When
oncotic pressure decreases, fluid shifts from the intravascular compartment into the interstitial space,
causing edema.
,Option c (Large glucose molecules increase) is incorrect because glucose molecules are not involved in
the pathophysiology of nephrotic syndrome. This description relates to hyperglycemia and osmotic
diuresis seen in diabetes mellitus, not nephrotic syndrome.
Option d (Oncotic pressure increases) is incorrect because oncotic pressure actually decreases in
nephrotic syndrome due to the loss of albumin. Increased oncotic pressure would cause fluid to move
into the capillaries, reducing edema, which is the opposite of what occurs in nephrotic syndrome.
3. The nurse preceptor has discussed with a newly hired nurse the types of urinary incontinence. Which
of the following statements by the newly hired nurse indicates a correct understanding of the
discussion?
a. "Stress incontinence develops in response to bladder lining irritants."
b. "Pregnancy puts a client at increased risk for having urge incontinence."
c. "Neuron demyelination causes a loss of messages to the bladder."
d. "Functional incontinence occurs due to a fecal impaction."
Correct ANSWER: c. "Neuron demyelination causes a loss of messages to the bladder."
Rationale:
Option a (Stress incontinence develops in response to bladder lining irritants) is incorrect because stress
incontinence results from weakened pelvic floor muscles and urethral sphincter incompetence, not
bladder irritants. Bladder irritants such as caffeine, alcohol, or infections cause urge incontinence, not
stress incontinence. Stress incontinence occurs when increased intra-abdominal pressure (coughing,
sneezing, laughing) exceeds urethral closure pressure.
Option b (Pregnancy puts a client at increased risk for having urge incontinence) is incorrect because
pregnancy primarily increases the risk for stress incontinence, not urge incontinence. The weight of the
growing fetus, hormonal changes, and increased intra-abdominal pressure weaken the pelvic floor
muscles and the urethral sphincter, leading to stress incontinence.
Option c (Neuron demyelination causes a loss of messages to the bladder) is correct because this
describes neurogenic bladder, which can result from conditions that cause demyelination of neurons
, (such as multiple sclerosis). Demyelination interrupts the transmission of neural signals between the
brain and the bladder, leading to loss of voluntary control and incontinence. This is a correct
understanding of the pathophysiology of neurogenic incontinence.
Option d (Functional incontinence occurs due to a fecal impaction) is incorrect because fecal impaction
typically causes overflow incontinence, not functional incontinence. Functional incontinence occurs
when a person has normal bladder function but cannot reach the toilet in time due to physical or
cognitive impairments (e.g., arthritis, dementia, mobility issues). Fecal impaction creates mechanical
obstruction and can cause overflow incontinence due to pressure on the bladder.
4. The nurse is providing care to a client diagnosed with nephrotic syndrome. The urinalysis reveals
proteinuria. Which of the following is the most likely cause for this finding?
a. The glomerular membrane has increased permeability which causes leakage of the protein.
b. Glomeruli are damaged by the immune system as part of the disease process causing protein to be
spilled.
c. The renal tubules become clogged with cellular debris causing the protein to be spilled.
d. Due to the nephrotoxic environment, the liver becomes overactive and synthesizes more protein.
Correct ANSWER: a. The glomerular membrane has increased permeability which causes leakage of the
protein.
Rationale:
Option a (The glomerular membrane has increased permeability) is correct because in nephrotic
syndrome, the glomerular basement membrane and podocytes are damaged, resulting in increased
permeability to plasma proteins. This allows large molecules such as albumin to pass through the
filtration barrier and be excreted in the urine. This is the primary pathophysiological mechanism of
proteinuria in nephrotic syndrome.
Option b (Glomeruli are damaged by the immune system) is incorrect because while some forms of
glomerular disease involve immune-mediated damage, nephrotic syndrome is primarily characterized by
increased permeability of the glomerular membrane rather than immune destruction. This explanation
is more consistent with glomerulonephritis, not nephrotic syndrome. Additionally, the immune system's
role is not the primary cause of proteinuria in nephrotic syndrome.
Comprehensive Practice Examination 2026
1. The nurse is caring for a client who has postinfectious acute glomerulonephritis. Which of the
following clinical manifestations should the nurse expect in this client?
a. Urinary hesitancy.
b. High glomerular filtration rate (GFR).
c. Hypertension and serum sodium of 129 mEq/L.
d. Smokey or coffee-colored urine.
Correct ANSWER: d. Smokey or coffee-colored urine.
Rationale:
Option a (Urinary hesitancy) is incorrect because urinary hesitancy is typically associated with benign
prostatic hyperplasia or urethral obstruction, not glomerulonephritis. Acute glomerulonephritis affects
the glomeruli, not the urethra or prostate.
Option b (High GFR) is incorrect because acute glomerulonephritis causes inflammation and damage to
the glomeruli, leading to decreased GFR, not increased. The filtration membrane becomes
compromised, reducing the kidney's ability to filter blood effectively.
Option c (Hypertension and serum sodium of 129 mEq/L) is partially correct regarding hypertension but
incorrect regarding sodium levels. In acute glomerulonephritis, sodium retention occurs due to
decreased GFR and activation of the renin-angiotensin-aldosterone system, leading to hypervolemia and
hypertension. Hyponatremia (129 mEq/L) is dilutional due to fluid retention, but the classic presentation
,includes hypertension with normal or slightly low sodium. However, the most characteristic finding is
hematuria.
Option d (Smokey or coffee-colored urine) is correct because postinfectious acute glomerulonephritis
causes damage to the glomerular basement membrane, allowing red blood cells to escape into the
urine. The RBCs are lysed and oxidized as they pass through the nephron, giving the urine a
characteristic smoky or coffee-colored appearance. This is the hallmark clinical manifestation of acute
glomerulonephritis.
2. The nurse is assessing edema in a client diagnosed with nephrotic syndrome. The nurse understands
that the edema is caused by
a. increased sodium loss leads to increased third spacing of fluids.
b. serum albumin is lost, oncotic pressure decreases allowing fluids to escape.
c. large glucose molecules increase and crowd out all other molecules.
d. oncotic pressure increases forcing fluids out into the interstitial spaces.
Correct ANSWER: b. serum albumin is lost, oncotic pressure decreases allowing fluids to escape.
Rationale:
Option a (Increased sodium loss) is incorrect because in nephrotic syndrome, sodium is retained, not
lost, due to the kidneys' compensatory mechanisms. Sodium retention contributes to edema, but it is
not the primary cause. The primary mechanism is loss of plasma proteins.
Option b (Serum albumin is lost, oncotic pressure decreases) is correct because nephrotic syndrome is
characterized by massive proteinuria (>3.5g/day). The glomerular membrane becomes excessively
permeable, allowing albumin to leak into the urine. This loss of albumin reduces plasma oncotic (colloid
osmotic) pressure, which normally pulls fluid from the interstitial space into the capillaries. When
oncotic pressure decreases, fluid shifts from the intravascular compartment into the interstitial space,
causing edema.
,Option c (Large glucose molecules increase) is incorrect because glucose molecules are not involved in
the pathophysiology of nephrotic syndrome. This description relates to hyperglycemia and osmotic
diuresis seen in diabetes mellitus, not nephrotic syndrome.
Option d (Oncotic pressure increases) is incorrect because oncotic pressure actually decreases in
nephrotic syndrome due to the loss of albumin. Increased oncotic pressure would cause fluid to move
into the capillaries, reducing edema, which is the opposite of what occurs in nephrotic syndrome.
3. The nurse preceptor has discussed with a newly hired nurse the types of urinary incontinence. Which
of the following statements by the newly hired nurse indicates a correct understanding of the
discussion?
a. "Stress incontinence develops in response to bladder lining irritants."
b. "Pregnancy puts a client at increased risk for having urge incontinence."
c. "Neuron demyelination causes a loss of messages to the bladder."
d. "Functional incontinence occurs due to a fecal impaction."
Correct ANSWER: c. "Neuron demyelination causes a loss of messages to the bladder."
Rationale:
Option a (Stress incontinence develops in response to bladder lining irritants) is incorrect because stress
incontinence results from weakened pelvic floor muscles and urethral sphincter incompetence, not
bladder irritants. Bladder irritants such as caffeine, alcohol, or infections cause urge incontinence, not
stress incontinence. Stress incontinence occurs when increased intra-abdominal pressure (coughing,
sneezing, laughing) exceeds urethral closure pressure.
Option b (Pregnancy puts a client at increased risk for having urge incontinence) is incorrect because
pregnancy primarily increases the risk for stress incontinence, not urge incontinence. The weight of the
growing fetus, hormonal changes, and increased intra-abdominal pressure weaken the pelvic floor
muscles and the urethral sphincter, leading to stress incontinence.
Option c (Neuron demyelination causes a loss of messages to the bladder) is correct because this
describes neurogenic bladder, which can result from conditions that cause demyelination of neurons
, (such as multiple sclerosis). Demyelination interrupts the transmission of neural signals between the
brain and the bladder, leading to loss of voluntary control and incontinence. This is a correct
understanding of the pathophysiology of neurogenic incontinence.
Option d (Functional incontinence occurs due to a fecal impaction) is incorrect because fecal impaction
typically causes overflow incontinence, not functional incontinence. Functional incontinence occurs
when a person has normal bladder function but cannot reach the toilet in time due to physical or
cognitive impairments (e.g., arthritis, dementia, mobility issues). Fecal impaction creates mechanical
obstruction and can cause overflow incontinence due to pressure on the bladder.
4. The nurse is providing care to a client diagnosed with nephrotic syndrome. The urinalysis reveals
proteinuria. Which of the following is the most likely cause for this finding?
a. The glomerular membrane has increased permeability which causes leakage of the protein.
b. Glomeruli are damaged by the immune system as part of the disease process causing protein to be
spilled.
c. The renal tubules become clogged with cellular debris causing the protein to be spilled.
d. Due to the nephrotoxic environment, the liver becomes overactive and synthesizes more protein.
Correct ANSWER: a. The glomerular membrane has increased permeability which causes leakage of the
protein.
Rationale:
Option a (The glomerular membrane has increased permeability) is correct because in nephrotic
syndrome, the glomerular basement membrane and podocytes are damaged, resulting in increased
permeability to plasma proteins. This allows large molecules such as albumin to pass through the
filtration barrier and be excreted in the urine. This is the primary pathophysiological mechanism of
proteinuria in nephrotic syndrome.
Option b (Glomeruli are damaged by the immune system) is incorrect because while some forms of
glomerular disease involve immune-mediated damage, nephrotic syndrome is primarily characterized by
increased permeability of the glomerular membrane rather than immune destruction. This explanation
is more consistent with glomerulonephritis, not nephrotic syndrome. Additionally, the immune system's
role is not the primary cause of proteinuria in nephrotic syndrome.
