NSG 526 – Renal and Genitourinary Disorders
Exam Questions & Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
A 68-year-old male with a history of heart failure presents with a blood
urea nitrogen of 45 mg/dL and a serum creatinine of 1.8 mg/dL. His
fractional excretion of sodium is calculated at 0.6 percent. Urine
sediment examination is unremarkable. Which type of acute kidney
injury is present?
A. Prerenal acute kidney injury
B. Acute tubular necrosis
C. Acute interstitial nephritis
D. Postrenal obstructive uropathy
CORRECT ANSWER: A
RATIONALE: A blood urea nitrogen to creatinine ratio greater than 20
to 1 combined with a fractional excretion of sodium less than 1 percent
indicates intact renal tubular sodium reabsorption in response to renal
hypoperfusion. This is characteristic of prerenal acute kidney injury
caused by decreased effective arterial blood volume in heart failure.
Question 2
A 42-year-old female presents with severe generalized edema,
hypoalbuminemia with a serum albumin of 2.1 g/dL, hyperlipidemia,
and 4+ proteinuria on urinalysis. A 24-hour urine collection confirms 4.2
grams of protein per day. Which renal clinical syndrome is represented
by these findings?
A. Nephritic syndrome
, B. Nephrotic syndrome
C. Rapidly progressive glomerulonephritis
D. Asymptomatic urinary abnormality
CORRECT ANSWER: B
RATIONALE: Nephrotic syndrome is defined by heavy proteinuria
greater than 3.5 grams per 24 hours, hypoalbuminemia, generalized
peripheral edema, and hyperlipidemia resulting from increased
glomerular capillary permeability to plasma proteins.
Question 3
A 28-year-old male presents with gross hematuria, elevated blood
pressure of 150/95 mmHg, and facial swelling 2 weeks after recovering
from a group A beta-hemolytic streptococcal pharyngitis. Microscopic
urinalysis reveals red blood cell casts. What is the primary
pathophysiological mechanism underlying his presentation?
A. Immune complex deposition within the glomerular basement
membrane triggering acute glomerular inflammation
B. Primary non-immune direct chemical toxicity of the proximal
renal tubules
C. Complete anatomical obstruction of the bilateral ureteropelvic
junctions
D. Malignant neoplastic infiltration of the renal parenchyma
CORRECT ANSWER: A
RATIONALE: Nephritic syndrome, classic for acute post-streptococcal
glomerulonephritis, involves glomerular inflammation driven by
immune complex deposition. This leads to capillary rupture, hematuria
with red blood cell casts, oliguria, hypertension, and mild-to-moderate
edema.
Question 4
,A 55-year-old male with stage 4 chronic kidney disease with an
estimated glomerular filtration rate of 22 mL per minute presents with
fatigue and dyspnea on exertion. Laboratory studies show a hemoglobin
of 8.2 g/dL, normal serum iron, normal total iron-binding capacity, and
normal ferritin. What is the main pathophysiological cause of anemia in
this patient?
A. Acute autoimmune destruction of circulating mature
erythrocytes
B. Deficiency of erythropoietin production by renal peritubular
interstitial cells
C. Severe chronic blood loss via the gastrointestinal tract
D. Profound dietary folate and vitamin B12 malabsorption
CORRECT ANSWER: B
RATIONALE: Chronic kidney disease leads to progressive destruction
of renal tissue, impairing the synthesis of erythropoietin by peritubular
interstitial fibroblasts. This results in normocytic, normochromic anemia
of chronic kidney disease.
Question 5
A 62-year-old female with long-standing end-stage renal disease
develops bone pain and subperiosteal bone resorption on radiographs.
Labs show elevated serum phosphate, low serum calcium, and markedly
elevated parathyroid hormone. What condition has developed?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism and renal osteodystrophy
C. Osteoporosis due to estrogen deficiency
D. Paget disease of bone
CORRECT ANSWER: B
RATIONALE: In advanced chronic kidney disease, impaired phosphate
excretion leads to hyperphosphatemia, while diminished active Vitamin
, D synthesis causes hypocalcemia. Together, hypocalcemia and
hyperphosphatemia continuously stimulate the parathyroid glands,
leading to secondary hyperparathyroidism and high-turnover bone
disease.
Question 6
A 35-year-old female presents with sudden left flank pain radiating to
the labia, accompanied by severe nausea and microhematuria. A non-
contrast computed tomography scan confirms a 4 mm calcium oxalate
calculus in the ureter. What is the initial recommended clinical
management for an uncomplicated stone of this size?
A. Immediate open surgical ureterolithotomy
B. Conservative medical expulsive therapy with hydration,
analgesia, and an alpha-1 blocker
C. Immediate percutaneous nephrolithotomy
D. Permanent urinary diversion via nephrostomy tube
CORRECT ANSWER: B
RATIONALE: Ureteral calculi under 5 mm in diameter have a high rate
of spontaneous passage. Initial management for uncomplicated cases
involves adequate oral hydration, pain control, and alpha-1 receptor
antagonists to relax ureteral smooth muscle and facilitate passage.
Question 7
A 70-year-old male presents with progressive urinary hesitancy, weak
stream, post-void dribbling, and nocturia 4 times per night. Digital rectal
exam reveals a smooth, symmetrically enlarged, non-tender prostate.
Which class of medication provides the fastest relief of lower urinary
tract symptoms by relaxing prostatic smooth muscle?
A. 5-alpha reductase inhibitors such as finasteride
B. Alpha-1 adrenergic receptor antagonists such as tamsulosin
C. Phosphodiesterase-5 inhibitors such as tadalafil
Exam Questions & Verified Answers with
Rationale Latest Edition 2026/2027
Question 1
A 68-year-old male with a history of heart failure presents with a blood
urea nitrogen of 45 mg/dL and a serum creatinine of 1.8 mg/dL. His
fractional excretion of sodium is calculated at 0.6 percent. Urine
sediment examination is unremarkable. Which type of acute kidney
injury is present?
A. Prerenal acute kidney injury
B. Acute tubular necrosis
C. Acute interstitial nephritis
D. Postrenal obstructive uropathy
CORRECT ANSWER: A
RATIONALE: A blood urea nitrogen to creatinine ratio greater than 20
to 1 combined with a fractional excretion of sodium less than 1 percent
indicates intact renal tubular sodium reabsorption in response to renal
hypoperfusion. This is characteristic of prerenal acute kidney injury
caused by decreased effective arterial blood volume in heart failure.
Question 2
A 42-year-old female presents with severe generalized edema,
hypoalbuminemia with a serum albumin of 2.1 g/dL, hyperlipidemia,
and 4+ proteinuria on urinalysis. A 24-hour urine collection confirms 4.2
grams of protein per day. Which renal clinical syndrome is represented
by these findings?
A. Nephritic syndrome
, B. Nephrotic syndrome
C. Rapidly progressive glomerulonephritis
D. Asymptomatic urinary abnormality
CORRECT ANSWER: B
RATIONALE: Nephrotic syndrome is defined by heavy proteinuria
greater than 3.5 grams per 24 hours, hypoalbuminemia, generalized
peripheral edema, and hyperlipidemia resulting from increased
glomerular capillary permeability to plasma proteins.
Question 3
A 28-year-old male presents with gross hematuria, elevated blood
pressure of 150/95 mmHg, and facial swelling 2 weeks after recovering
from a group A beta-hemolytic streptococcal pharyngitis. Microscopic
urinalysis reveals red blood cell casts. What is the primary
pathophysiological mechanism underlying his presentation?
A. Immune complex deposition within the glomerular basement
membrane triggering acute glomerular inflammation
B. Primary non-immune direct chemical toxicity of the proximal
renal tubules
C. Complete anatomical obstruction of the bilateral ureteropelvic
junctions
D. Malignant neoplastic infiltration of the renal parenchyma
CORRECT ANSWER: A
RATIONALE: Nephritic syndrome, classic for acute post-streptococcal
glomerulonephritis, involves glomerular inflammation driven by
immune complex deposition. This leads to capillary rupture, hematuria
with red blood cell casts, oliguria, hypertension, and mild-to-moderate
edema.
Question 4
,A 55-year-old male with stage 4 chronic kidney disease with an
estimated glomerular filtration rate of 22 mL per minute presents with
fatigue and dyspnea on exertion. Laboratory studies show a hemoglobin
of 8.2 g/dL, normal serum iron, normal total iron-binding capacity, and
normal ferritin. What is the main pathophysiological cause of anemia in
this patient?
A. Acute autoimmune destruction of circulating mature
erythrocytes
B. Deficiency of erythropoietin production by renal peritubular
interstitial cells
C. Severe chronic blood loss via the gastrointestinal tract
D. Profound dietary folate and vitamin B12 malabsorption
CORRECT ANSWER: B
RATIONALE: Chronic kidney disease leads to progressive destruction
of renal tissue, impairing the synthesis of erythropoietin by peritubular
interstitial fibroblasts. This results in normocytic, normochromic anemia
of chronic kidney disease.
Question 5
A 62-year-old female with long-standing end-stage renal disease
develops bone pain and subperiosteal bone resorption on radiographs.
Labs show elevated serum phosphate, low serum calcium, and markedly
elevated parathyroid hormone. What condition has developed?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism and renal osteodystrophy
C. Osteoporosis due to estrogen deficiency
D. Paget disease of bone
CORRECT ANSWER: B
RATIONALE: In advanced chronic kidney disease, impaired phosphate
excretion leads to hyperphosphatemia, while diminished active Vitamin
, D synthesis causes hypocalcemia. Together, hypocalcemia and
hyperphosphatemia continuously stimulate the parathyroid glands,
leading to secondary hyperparathyroidism and high-turnover bone
disease.
Question 6
A 35-year-old female presents with sudden left flank pain radiating to
the labia, accompanied by severe nausea and microhematuria. A non-
contrast computed tomography scan confirms a 4 mm calcium oxalate
calculus in the ureter. What is the initial recommended clinical
management for an uncomplicated stone of this size?
A. Immediate open surgical ureterolithotomy
B. Conservative medical expulsive therapy with hydration,
analgesia, and an alpha-1 blocker
C. Immediate percutaneous nephrolithotomy
D. Permanent urinary diversion via nephrostomy tube
CORRECT ANSWER: B
RATIONALE: Ureteral calculi under 5 mm in diameter have a high rate
of spontaneous passage. Initial management for uncomplicated cases
involves adequate oral hydration, pain control, and alpha-1 receptor
antagonists to relax ureteral smooth muscle and facilitate passage.
Question 7
A 70-year-old male presents with progressive urinary hesitancy, weak
stream, post-void dribbling, and nocturia 4 times per night. Digital rectal
exam reveals a smooth, symmetrically enlarged, non-tender prostate.
Which class of medication provides the fastest relief of lower urinary
tract symptoms by relaxing prostatic smooth muscle?
A. 5-alpha reductase inhibitors such as finasteride
B. Alpha-1 adrenergic receptor antagonists such as tamsulosin
C. Phosphodiesterase-5 inhibitors such as tadalafil
