NSG 3850 Patho Exam 3 Review: Renal and Urinary
Disorders
Comprehensive Exam Questions with Rationales 2026
1. A 68-year-old female patient reports leaking urine when she coughs and sneezes. Which
pathophysiological mechanism is most likely responsible for this type of incontinence?
A) Detrusor muscle overactivity
B) Weakening of pelvic floor muscles
C) Spinal cord compression
D) Bladder outlet obstruction
ANSWER✔✨--: B) Weakening of pelvic floor muscles
Rationale: Stress incontinence occurs when pelvic floor muscles weaken, leading to inadequate support
of the bladder neck and urethra. Increased intra-abdominal pressure from coughing, sneezing, laughing,
or physical activity overcomes urethral sphincter pressure, resulting in urine leakage. This is the hallmark
characteristic of stress incontinence. Detrusor overactivity causes urge incontinence, not stress. Spinal
cord compression and bladder outlet obstruction would typically cause different urinary symptoms.
2. A patient with multiple sclerosis develops urinary incontinence. Which type of incontinence is most
commonly associated with this neurological condition?
A) Stress incontinence
B) Overflow incontinence
C) Urge incontinence
D) Functional incontinence
,ANSWER✔✨--: C) Urge incontinence
Rationale: Multiple sclerosis causes demyelination of neurons, affecting neural pathways that control
the detrusor muscle and bladder function. This disruption in nerve signaling leads to uninhibited
detrusor contractions, resulting in urge incontinence. Stress incontinence is primarily due to pelvic floor
weakness. Overflow incontinence occurs with bladder outlet obstruction or detrusor underactivity.
Functional incontinence relates to physical or cognitive barriers preventing timely toileting.
3. A patient with chronic kidney disease has the following laboratory findings. Which result indicates a
complication of CKD that requires intervention?
A) Serum calcium: 10.2 mg/dL
B) Serum phosphorus: 2.5 mg/dL
C) Serum potassium: 5.8 mEq/L
D) Hemoglobin: 14.0 g/dL
ANSWER✔✨--: C) Serum potassium: 5.8 mEq/L
Rationale: Hyperkalemia (potassium >5.0-5.5 mEq/L) is a life-threatening complication of CKD due to
decreased renal excretion of potassium. It can cause cardiac arrhythmias and requires immediate
intervention. Normal calcium is 8.5-10.5 mg/dL, so 10.2 is normal. Normal phosphorus is 2.5-4.5 mg/dL,
so 2.5 is within normal limits. A hemoglobin of 14.0 g/dL is normal and would not be expected in CKD
patients who typically have anemia due to decreased erythropoietin production.
4. Which statement accurately describes the progression of chronic kidney disease?
A) Symptoms become apparent when 25-30% of nephrons are damaged
B) Progression becomes clinically evident after 50% of nephrons are lost
C) Damage does not become clinically apparent until 75-80% of nephrons are damaged
D) Clinical manifestations occur as soon as any nephron damage occurs
,ANSWER✔✨--: C) Damage does not become clinically apparent until 75-80% of nephrons are
damaged
Rationale: CKD progresses silently for a long period because of the kidney's remarkable functional
reserve capacity. When approximately 75-80% of nephrons are damaged or nonfunctional, the
remaining nephrons can no longer compensate adequately, leading to clinically detectable changes in
laboratory values and symptoms. This explains why patients may have significant kidney damage before
seeking medical attention.
5. In a patient with chronic kidney disease, which laboratory value pattern is expected?
A) Elevated BUN, elevated creatinine, elevated calcium, low phosphate
B) Elevated BUN, elevated creatinine, low calcium, high phosphate
C) Low BUN, low creatinine, low calcium, low phosphate
D) Normal BUN, elevated creatinine, low calcium, high phosphate
ANSWER✔✨--: B) Elevated BUN, elevated creatinine, low calcium, high phosphate
Rationale: In CKD, BUN and creatinine are elevated because the kidneys cannot effectively excrete
nitrogenous waste products. Calcium is low due to decreased renal production of active vitamin D,
reduced intestinal calcium absorption, and hyperphosphatemia. Phosphate is elevated because the
kidneys cannot excrete phosphate effectively. This pattern reflects the hallmark metabolic disturbances
of CKD.
6. Which statement best explains the pathophysiology of secondary hyperparathyroidism in chronic
kidney disease?
A) The parathyroid glands become atrophic due to uremic toxins
B) Low serum calcium stimulates the parathyroid glands to increase secretion
C) High serum phosphorus directly inhibits parathyroid hormone release
D) The parathyroid glands enlarge in response to increased calcium levels
, ANSWER✔✨--: B) Low serum calcium stimulates the parathyroid glands to increase secretion
Rationale: In CKD, low serum calcium (due to decreased vitamin D synthesis and hyperphosphatemia)
stimulates the parathyroid glands to increase parathyroid hormone secretion in an attempt to raise
calcium levels. This compensatory mechanism leads to secondary hyperparathyroidism with elevated
PTH levels. The parathyroid glands are not atrophic but become hyperplastic. High phosphorus does not
inhibit PTH; in fact, it further stimulates PTH secretion.
7. A 45-year-old female with a BMI of 38 reports sudden, intense urgency to urinate and involuntary loss
of urine before reaching the bathroom. Which risk factor is most relevant to her condition?
A) History of prostate enlargement
B) Increased age and elevated BMI
C) Recent bladder infection
D) Use of anticholinergic medications
ANSWER✔✨--: B) Increased age and elevated BMI
Rationale: The patient is describing urge incontinence, characterized by sudden intense urgency with
involuntary urine loss. Elevated BMI is a significant risk factor for urge incontinence, likely due to
increased intra-abdominal pressure and potential effects on bladder function. Increased age is also a risk
factor. Prostate enlargement is relevant to male patients, not female. Bladder infections can cause
transient urge symptoms but would typically have additional findings. Anticholinergic medications are
used to treat, not cause, urge incontinence.
8. An elderly patient with no history of urinary symptoms develops acute confusion, urinary frequency,
and burning with urination. What is the most likely underlying cause?
A) Dehydration
B) Urinary tract infection
C) Medication side effect
D) Normal age-related changes
Disorders
Comprehensive Exam Questions with Rationales 2026
1. A 68-year-old female patient reports leaking urine when she coughs and sneezes. Which
pathophysiological mechanism is most likely responsible for this type of incontinence?
A) Detrusor muscle overactivity
B) Weakening of pelvic floor muscles
C) Spinal cord compression
D) Bladder outlet obstruction
ANSWER✔✨--: B) Weakening of pelvic floor muscles
Rationale: Stress incontinence occurs when pelvic floor muscles weaken, leading to inadequate support
of the bladder neck and urethra. Increased intra-abdominal pressure from coughing, sneezing, laughing,
or physical activity overcomes urethral sphincter pressure, resulting in urine leakage. This is the hallmark
characteristic of stress incontinence. Detrusor overactivity causes urge incontinence, not stress. Spinal
cord compression and bladder outlet obstruction would typically cause different urinary symptoms.
2. A patient with multiple sclerosis develops urinary incontinence. Which type of incontinence is most
commonly associated with this neurological condition?
A) Stress incontinence
B) Overflow incontinence
C) Urge incontinence
D) Functional incontinence
,ANSWER✔✨--: C) Urge incontinence
Rationale: Multiple sclerosis causes demyelination of neurons, affecting neural pathways that control
the detrusor muscle and bladder function. This disruption in nerve signaling leads to uninhibited
detrusor contractions, resulting in urge incontinence. Stress incontinence is primarily due to pelvic floor
weakness. Overflow incontinence occurs with bladder outlet obstruction or detrusor underactivity.
Functional incontinence relates to physical or cognitive barriers preventing timely toileting.
3. A patient with chronic kidney disease has the following laboratory findings. Which result indicates a
complication of CKD that requires intervention?
A) Serum calcium: 10.2 mg/dL
B) Serum phosphorus: 2.5 mg/dL
C) Serum potassium: 5.8 mEq/L
D) Hemoglobin: 14.0 g/dL
ANSWER✔✨--: C) Serum potassium: 5.8 mEq/L
Rationale: Hyperkalemia (potassium >5.0-5.5 mEq/L) is a life-threatening complication of CKD due to
decreased renal excretion of potassium. It can cause cardiac arrhythmias and requires immediate
intervention. Normal calcium is 8.5-10.5 mg/dL, so 10.2 is normal. Normal phosphorus is 2.5-4.5 mg/dL,
so 2.5 is within normal limits. A hemoglobin of 14.0 g/dL is normal and would not be expected in CKD
patients who typically have anemia due to decreased erythropoietin production.
4. Which statement accurately describes the progression of chronic kidney disease?
A) Symptoms become apparent when 25-30% of nephrons are damaged
B) Progression becomes clinically evident after 50% of nephrons are lost
C) Damage does not become clinically apparent until 75-80% of nephrons are damaged
D) Clinical manifestations occur as soon as any nephron damage occurs
,ANSWER✔✨--: C) Damage does not become clinically apparent until 75-80% of nephrons are
damaged
Rationale: CKD progresses silently for a long period because of the kidney's remarkable functional
reserve capacity. When approximately 75-80% of nephrons are damaged or nonfunctional, the
remaining nephrons can no longer compensate adequately, leading to clinically detectable changes in
laboratory values and symptoms. This explains why patients may have significant kidney damage before
seeking medical attention.
5. In a patient with chronic kidney disease, which laboratory value pattern is expected?
A) Elevated BUN, elevated creatinine, elevated calcium, low phosphate
B) Elevated BUN, elevated creatinine, low calcium, high phosphate
C) Low BUN, low creatinine, low calcium, low phosphate
D) Normal BUN, elevated creatinine, low calcium, high phosphate
ANSWER✔✨--: B) Elevated BUN, elevated creatinine, low calcium, high phosphate
Rationale: In CKD, BUN and creatinine are elevated because the kidneys cannot effectively excrete
nitrogenous waste products. Calcium is low due to decreased renal production of active vitamin D,
reduced intestinal calcium absorption, and hyperphosphatemia. Phosphate is elevated because the
kidneys cannot excrete phosphate effectively. This pattern reflects the hallmark metabolic disturbances
of CKD.
6. Which statement best explains the pathophysiology of secondary hyperparathyroidism in chronic
kidney disease?
A) The parathyroid glands become atrophic due to uremic toxins
B) Low serum calcium stimulates the parathyroid glands to increase secretion
C) High serum phosphorus directly inhibits parathyroid hormone release
D) The parathyroid glands enlarge in response to increased calcium levels
, ANSWER✔✨--: B) Low serum calcium stimulates the parathyroid glands to increase secretion
Rationale: In CKD, low serum calcium (due to decreased vitamin D synthesis and hyperphosphatemia)
stimulates the parathyroid glands to increase parathyroid hormone secretion in an attempt to raise
calcium levels. This compensatory mechanism leads to secondary hyperparathyroidism with elevated
PTH levels. The parathyroid glands are not atrophic but become hyperplastic. High phosphorus does not
inhibit PTH; in fact, it further stimulates PTH secretion.
7. A 45-year-old female with a BMI of 38 reports sudden, intense urgency to urinate and involuntary loss
of urine before reaching the bathroom. Which risk factor is most relevant to her condition?
A) History of prostate enlargement
B) Increased age and elevated BMI
C) Recent bladder infection
D) Use of anticholinergic medications
ANSWER✔✨--: B) Increased age and elevated BMI
Rationale: The patient is describing urge incontinence, characterized by sudden intense urgency with
involuntary urine loss. Elevated BMI is a significant risk factor for urge incontinence, likely due to
increased intra-abdominal pressure and potential effects on bladder function. Increased age is also a risk
factor. Prostate enlargement is relevant to male patients, not female. Bladder infections can cause
transient urge symptoms but would typically have additional findings. Anticholinergic medications are
used to treat, not cause, urge incontinence.
8. An elderly patient with no history of urinary symptoms develops acute confusion, urinary frequency,
and burning with urination. What is the most likely underlying cause?
A) Dehydration
B) Urinary tract infection
C) Medication side effect
D) Normal age-related changes
