NRS 455 Exam 3 V2 | NRS 455
Pathophysiology | Actual Q&A with
Rationale (NRS455 Exam 3) | Grand
Canyon University
1. A nurse is assessing a patient with Nephrotic Syndrome. Which of the following clinical
manifestations are characteristic of this condition? (Select All That Apply)
A. Massive proteinuria (>3.5g/day)
B. Hypoalbuminemia
C. Generalized edema (Anasarca)
D. Hyperlipidemia
E. Lipiduria
F. Gross hematuria (cola-colored urine)
Correct Correct Answer: A, B, C, D, E
Rationale: Nephrotic syndrome is characterized by heavy proteinuria due to increased
glomerular permeability, which subsequently leads to hypoalbuminemia as the liver cannot
keep up with protein loss. The resulting decrease in plasma oncotic pressure causes fluid to
shift into the interstitial space, leading to significant edema. Additionally, the liver
increases lipoprotein synthesis in response to low protein levels, resulting in
hyperlipidemia and the presence of lipids in the urine.
,2. Which of the following conditions is the most common cause of prerenal acute kidney
injury (AKI)?
A. Acute tubular necrosis
B. Benign prostatic hyperplasia
C. Glomerulonephritis
D. Hypovolemia and dehydration
Correct Correct Answer: D
Rationale: Prerenal AKI is primarily caused by factors that reduce systemic blood flow and
decrease renal perfusion. Hypovolemia and dehydration lead to a drop in glomerular
filtration rate because the kidneys are not receiving adequate pressure to function. Unlike
intrarenal causes, the kidney tissue remains structurally intact initially but is functionally
impaired due to hemodynamic factors.
3. A patient is diagnosed with post-streptococcal glomerulonephritis. The nurse understands
this is caused by:
A. Direct viral invasion of the renal parenchyma
B. Deposition of immune complexes in the glomerular basement membrane
C. Chronic hypertension causing sclerotic changes
D. Ascending infection from the lower urinary tract
Correct Correct Answer: B
,Rationale: Post-streptococcal glomerulonephritis is a Type III hypersensitivity reaction
occurring after a skin or throat infection. It involves the formation and deposition of
antigen-antibody complexes within the glomerular filtration barrier, triggering an
inflammatory response. This inflammation damages the capillaries, leading to symptoms
such as hematuria and hypertension.
4. What is the primary pathophysiology behind anemia in patients with stage 4 or 5 Chronic
Kidney Disease (CKD)?
A. Inadequate production of erythropoietin by the kidneys
B. Increased destruction of red blood cells by the spleen
C. Chronic gastrointestinal bleeding
D. Vitamin B12 deficiency due to poor diet
Correct Correct Answer: A
Rationale: As renal function declines, the peritubular cells in the kidneys lose the ability to
produce erythropoietin, the hormone responsible for stimulating red blood cell production
in the bone marrow. This hormone deficiency is the most significant contributor to the
normocytic, normochromic anemia seen in CKD. Patients often require exogenous
administration of erythropoiesis-stimulating agents to maintain hemoglobin levels.
5. A patient with CKD develops renal osteodystrophy. Which of the following best describes
the underlying mechanism?
A. Hyperphosphatemia and hypocalcemia stimulating PTH release
, B. Hypercalcemia suppressing parathyroid hormone
C. Excessive vitamin D activation by the kidneys
D. Increased renal excretion of calcium
Correct Correct Answer: A
Rationale: In CKD, impaired phosphorus excretion leads to hyperphosphatemia, which
binds with calcium and lowers serum calcium levels. Additionally, the failing kidneys
cannot activate Vitamin D, which is essential for calcium absorption, further worsening
hypocalcemia. The high phosphorus and low calcium levels trigger the parathyroid glands
to release PTH, which leaches calcium from the bones, leading to skeletal softening and
fractures.
6. Which clinical scenario represents a postrenal cause of Acute Kidney Injury?
A. Anaphylactic shock following medication administration
B. Bilateral ureteral obstruction by kidney stones
C. Nephrotoxic damage from aminoglycoside antibiotics
D. Sepsis leading to acute tubular necrosis
Correct Correct Answer: B
Rationale: Postrenal AKI occurs when there is a physical obstruction to urine flow
anywhere between the kidney and the urethral meatus. Mechanical obstructions, such as
stones, tumors, or prostatic hypertrophy, increase retrograde pressure within the renal
Pathophysiology | Actual Q&A with
Rationale (NRS455 Exam 3) | Grand
Canyon University
1. A nurse is assessing a patient with Nephrotic Syndrome. Which of the following clinical
manifestations are characteristic of this condition? (Select All That Apply)
A. Massive proteinuria (>3.5g/day)
B. Hypoalbuminemia
C. Generalized edema (Anasarca)
D. Hyperlipidemia
E. Lipiduria
F. Gross hematuria (cola-colored urine)
Correct Correct Answer: A, B, C, D, E
Rationale: Nephrotic syndrome is characterized by heavy proteinuria due to increased
glomerular permeability, which subsequently leads to hypoalbuminemia as the liver cannot
keep up with protein loss. The resulting decrease in plasma oncotic pressure causes fluid to
shift into the interstitial space, leading to significant edema. Additionally, the liver
increases lipoprotein synthesis in response to low protein levels, resulting in
hyperlipidemia and the presence of lipids in the urine.
,2. Which of the following conditions is the most common cause of prerenal acute kidney
injury (AKI)?
A. Acute tubular necrosis
B. Benign prostatic hyperplasia
C. Glomerulonephritis
D. Hypovolemia and dehydration
Correct Correct Answer: D
Rationale: Prerenal AKI is primarily caused by factors that reduce systemic blood flow and
decrease renal perfusion. Hypovolemia and dehydration lead to a drop in glomerular
filtration rate because the kidneys are not receiving adequate pressure to function. Unlike
intrarenal causes, the kidney tissue remains structurally intact initially but is functionally
impaired due to hemodynamic factors.
3. A patient is diagnosed with post-streptococcal glomerulonephritis. The nurse understands
this is caused by:
A. Direct viral invasion of the renal parenchyma
B. Deposition of immune complexes in the glomerular basement membrane
C. Chronic hypertension causing sclerotic changes
D. Ascending infection from the lower urinary tract
Correct Correct Answer: B
,Rationale: Post-streptococcal glomerulonephritis is a Type III hypersensitivity reaction
occurring after a skin or throat infection. It involves the formation and deposition of
antigen-antibody complexes within the glomerular filtration barrier, triggering an
inflammatory response. This inflammation damages the capillaries, leading to symptoms
such as hematuria and hypertension.
4. What is the primary pathophysiology behind anemia in patients with stage 4 or 5 Chronic
Kidney Disease (CKD)?
A. Inadequate production of erythropoietin by the kidneys
B. Increased destruction of red blood cells by the spleen
C. Chronic gastrointestinal bleeding
D. Vitamin B12 deficiency due to poor diet
Correct Correct Answer: A
Rationale: As renal function declines, the peritubular cells in the kidneys lose the ability to
produce erythropoietin, the hormone responsible for stimulating red blood cell production
in the bone marrow. This hormone deficiency is the most significant contributor to the
normocytic, normochromic anemia seen in CKD. Patients often require exogenous
administration of erythropoiesis-stimulating agents to maintain hemoglobin levels.
5. A patient with CKD develops renal osteodystrophy. Which of the following best describes
the underlying mechanism?
A. Hyperphosphatemia and hypocalcemia stimulating PTH release
, B. Hypercalcemia suppressing parathyroid hormone
C. Excessive vitamin D activation by the kidneys
D. Increased renal excretion of calcium
Correct Correct Answer: A
Rationale: In CKD, impaired phosphorus excretion leads to hyperphosphatemia, which
binds with calcium and lowers serum calcium levels. Additionally, the failing kidneys
cannot activate Vitamin D, which is essential for calcium absorption, further worsening
hypocalcemia. The high phosphorus and low calcium levels trigger the parathyroid glands
to release PTH, which leaches calcium from the bones, leading to skeletal softening and
fractures.
6. Which clinical scenario represents a postrenal cause of Acute Kidney Injury?
A. Anaphylactic shock following medication administration
B. Bilateral ureteral obstruction by kidney stones
C. Nephrotoxic damage from aminoglycoside antibiotics
D. Sepsis leading to acute tubular necrosis
Correct Correct Answer: B
Rationale: Postrenal AKI occurs when there is a physical obstruction to urine flow
anywhere between the kidney and the urethral meatus. Mechanical obstructions, such as
stones, tumors, or prostatic hypertrophy, increase retrograde pressure within the renal
