NURS 5315 Exam 4 V3 | NURS 5315
Advanced Pathophysiology | Actual Q&A
with Rationale (NURS5315 Exam 4) | The
University of Texas at Arlington
1. A patient with chronic kidney disease (CKD) presents with severe anemia. Which
pathophysiological mechanism is primarily responsible for this finding?
A. Increased destruction of red blood cells due to metabolic acidosis
B. Inadequate production of erythropoietin by the peritubular cells of the kidney
C. Chronic blood loss through the gastrointestinal tract secondary to uremia
D. Iron deficiency caused by restricted dietary intake in renal patients
Answer: B
Rationale: The kidneys are the primary site for the production of erythropoietin, which
stimulates the bone marrow to produce red blood cells. As renal function declines in CKD,
the kidneys fail to produce sufficient levels of this hormone. This leads to a normochromic,
normocytic anemia that requires exogenous replacement for management.
2. Which clinical manifestation is most characteristic of nephrotic syndrome rather than
nephritic syndrome?
A. Gross hematuria resulting in smoky or cola-colored urine
B. Elevated serum creatinine and blood urea nitrogen (BUN) levels
,C. Acute hypertension caused by fluid volume overload
D. Severe generalized edema due to massive proteinuria exceeding 3.5 g/day
Answer: D
Rationale: Nephrotic syndrome is defined by a significant increase in glomerular
permeability to proteins, resulting in massive urinary protein loss. This leads to
hypoalbuminemia, which decreases plasma oncotic pressure and causes systemic edema.
In contrast, nephritic syndrome is characterized more by inflammation, hematuria, and
mild to moderate proteinuria.
3. In the development of post-streptococcal glomerulonephritis, what is the underlying
immunological mechanism?
A. Type I hypersensitivity reaction involving IgE and mast cell degranulation
B. Type III hypersensitivity reaction involving the deposition of antigen-antibody
complexes
C. Direct cytotoxic T-cell attack on the basement membrane of the glomerulus
D. Autoantibody production against the glomerular filtration slits
Answer: B
Rationale: Post-streptococcal glomerulonephritis occurs when immune complexes formed
during a recent infection deposit in the glomerular wall. These complexes trigger the
complement system and attract inflammatory cells, leading to glomerular damage. This
process typically manifests several weeks after a pharyngeal or skin infection.
, 4. A patient is diagnosed with acute tubular necrosis (ATN). Which phase of ATN is associated
with the lowest urine output and the highest risk of metabolic complications?
A. Maintenance (oliguric) phase
B. Initiation phase
C. Diuretic phase
D. Recovery (convalescent) phase
Answer: A
Rationale: The maintenance phase of ATN is characterized by a significant drop in GFR and
minimal urine production. During this time, patients are at high risk for hyperkalemia,
metabolic acidosis, and fluid volume excess. This phase can last from days to weeks before
the tubular epithelium begins to regenerate.
5. What is the primary cause of prerenal acute kidney injury (AKI)?
A. Obstruction of the urinary tract by kidney stones or prostatic hypertrophy
B. Direct damage to the renal parenchyma from nephrotoxic medications
C. Reduced renal perfusion and decreased blood flow to the kidneys
D. Inflammation of the interstitial tissue within the renal cortex
Answer: C
Rationale: Prerenal AKI occurs when there is an external factor reducing blood flow to the
kidney, such as hypovolemia, hypotension, or heart failure. Because the kidney tissue itself
Advanced Pathophysiology | Actual Q&A
with Rationale (NURS5315 Exam 4) | The
University of Texas at Arlington
1. A patient with chronic kidney disease (CKD) presents with severe anemia. Which
pathophysiological mechanism is primarily responsible for this finding?
A. Increased destruction of red blood cells due to metabolic acidosis
B. Inadequate production of erythropoietin by the peritubular cells of the kidney
C. Chronic blood loss through the gastrointestinal tract secondary to uremia
D. Iron deficiency caused by restricted dietary intake in renal patients
Answer: B
Rationale: The kidneys are the primary site for the production of erythropoietin, which
stimulates the bone marrow to produce red blood cells. As renal function declines in CKD,
the kidneys fail to produce sufficient levels of this hormone. This leads to a normochromic,
normocytic anemia that requires exogenous replacement for management.
2. Which clinical manifestation is most characteristic of nephrotic syndrome rather than
nephritic syndrome?
A. Gross hematuria resulting in smoky or cola-colored urine
B. Elevated serum creatinine and blood urea nitrogen (BUN) levels
,C. Acute hypertension caused by fluid volume overload
D. Severe generalized edema due to massive proteinuria exceeding 3.5 g/day
Answer: D
Rationale: Nephrotic syndrome is defined by a significant increase in glomerular
permeability to proteins, resulting in massive urinary protein loss. This leads to
hypoalbuminemia, which decreases plasma oncotic pressure and causes systemic edema.
In contrast, nephritic syndrome is characterized more by inflammation, hematuria, and
mild to moderate proteinuria.
3. In the development of post-streptococcal glomerulonephritis, what is the underlying
immunological mechanism?
A. Type I hypersensitivity reaction involving IgE and mast cell degranulation
B. Type III hypersensitivity reaction involving the deposition of antigen-antibody
complexes
C. Direct cytotoxic T-cell attack on the basement membrane of the glomerulus
D. Autoantibody production against the glomerular filtration slits
Answer: B
Rationale: Post-streptococcal glomerulonephritis occurs when immune complexes formed
during a recent infection deposit in the glomerular wall. These complexes trigger the
complement system and attract inflammatory cells, leading to glomerular damage. This
process typically manifests several weeks after a pharyngeal or skin infection.
, 4. A patient is diagnosed with acute tubular necrosis (ATN). Which phase of ATN is associated
with the lowest urine output and the highest risk of metabolic complications?
A. Maintenance (oliguric) phase
B. Initiation phase
C. Diuretic phase
D. Recovery (convalescent) phase
Answer: A
Rationale: The maintenance phase of ATN is characterized by a significant drop in GFR and
minimal urine production. During this time, patients are at high risk for hyperkalemia,
metabolic acidosis, and fluid volume excess. This phase can last from days to weeks before
the tubular epithelium begins to regenerate.
5. What is the primary cause of prerenal acute kidney injury (AKI)?
A. Obstruction of the urinary tract by kidney stones or prostatic hypertrophy
B. Direct damage to the renal parenchyma from nephrotoxic medications
C. Reduced renal perfusion and decreased blood flow to the kidneys
D. Inflammation of the interstitial tissue within the renal cortex
Answer: C
Rationale: Prerenal AKI occurs when there is an external factor reducing blood flow to the
kidney, such as hypovolemia, hypotension, or heart failure. Because the kidney tissue itself
