NUR 376 Exam 2 – Applied Pathophysiology –
(2026) Actual Questions & Answers
(Concordia) 100% Guarantee Pass
SECTION 1: RENAL PATHOPHYSIOLOGY
1. A patient is suffering declining kidney function due to an autoimmune
disease. The patient asks the nurse how much of their kidney must suffer
damage to lead to end-stage renal disease (ESRD). Which of the following is the
appropriate response by the nurse?
• A) "Usually ESRD develops when less than 10% of the nephrons are
damaged."
• B) "Usually ESRD develops when 10% to 20% of the nephrons are
damaged."
• C) "Usually ESRD develops when 65% to 75% of the nephrons are
damaged."
• D) "Usually ESRD develops when 90% to 95% of the nephrons are
damaged."
Answer: D) "Usually ESRD develops when 90% to 95% of the nephrons are
damaged."
Rationale: The kidneys possess substantial functional reserve. Clinical
manifestations of renal failure typically do not appear until the glomerular
filtration rate (GFR) drops below 15–20 mL/min, which corresponds to the
destruction of approximately 90–95% of nephrons. At this stage, the remaining
nephrons cannot compensate through hyperfiltration, leading to uremic toxin
accumulation and the need for renal replacement therapy.
,2. A patient with severe renal failure may develop osteoporosis. Which factor
may play a role in this development?
• A) Kidneys are unable to activate vitamin D
• B) Kidneys are unable to activate vitamin C
• C) Renal patients must avoid the sunlight
• D) Kidneys are unable to synthesize erythropoietin
Answer: A) Kidneys are unable to activate vitamin D
Rationale: The kidneys perform the 1α-hydroxylation of 25-hydroxyvitamin D to its
active form, 1,25-dihydroxyvitamin D (calcitriol). In renal failure, this activation is
impaired, leading to hypocalcemia, secondary hyperparathyroidism, and renal
osteodystrophy, which includes osteoporosis and osteomalacia. Erythropoietin
deficiency causes anemia, not bone disease.
3. A patient with an obstruction of urine outflow anywhere distal to the renal
pelvis is experiencing which type of acute kidney injury?
• A) Prerenal
• B) Intrarenal
• C) Postrenal
• D) Juxtarenal
Answer: C) Postrenal
Rationale: Postrenal acute kidney injury is caused by obstruction of urine outflow
anywhere distal to the renal pelvis (ureter, bladder, urethra). Prerenal AKI involves
hypoperfusion (shock, dehydration). Intrarenal AKI involves parenchymal damage
(nephrotoxicity, glomerulonephritis). "Juxtarenal" is not a standard classification of
renal dysfunction.
,4. A nurse is evaluating a patient's risk for renal disorders. Which of the
following increase the risk for renal dysfunction? (Select all that apply)
• A) A patient with diabetes mellitus
• B) A patient with severe hypertension
• C) A patient with systemic lupus erythematosus
• D) A patient with cirrhosis
• E) A patient with peptic ulcer disease
Answer: A, B, C, and D
Rationale: Diabetes mellitus causes diabetic nephropathy through hyperglycemia-
induced glomerular hyperfiltration and basement membrane thickening. Severe
hypertension causes hypertensive nephrosclerosis. SLE causes immune complex-
mediated glomerulonephritis. Cirrhosis leads to hepatorenal syndrome and
functional renal failure through portal hypertension and splanchnic vasodilation.
Peptic ulcer disease does not directly impair renal function.
5. A female patient experiences urinary incontinence whenever she coughs or
sneezes. Otherwise, she states she has no urinary problems. What type of
incontinence is she experiencing?
• A) Neurogenic
• B) Overactive bladder
• C) Overflow
• D) Stress
Answer: D) Stress
Rationale: Stress urinary incontinence occurs when intra-abdominal pressure
exceeds urethral sphincter resistance during activities such as coughing, sneezing,
, laughing, or lifting. It results from pelvic floor weakness, urethral hypermobility, or
sphincter deficiency. Neurogenic incontinence involves neurologic disease.
Overactive bladder causes urgency and frequency. Overflow incontinence presents
with continuous dribbling from bladder distension and incomplete emptying.
6. A patient passes a kidney stone. What is the most likely composition of the
stone?
• A) Cystine
• B) Uric acid
• C) Calcium
• D) Magnesium
Answer: C) Calcium
Rationale: Calcium-containing stones (calcium oxalate and calcium phosphate)
account for approximately 80% of all kidney stones. They form in conditions of
hypercalciuria, hyperoxaluria, or hypocitraturia. Cystine stones occur only in
cystinuria (an autosomal recessive disorder). Uric acid stones comprise 5–10% and
form in acidic urine or gout. Magnesium is a stone inhibitor, not a primary stone
constituent.
7. Which of the following would alert the clinician that the patient may have
acute glomerulonephritis? (Select all that apply)
• A) Pain with urination
• B) Protein in urine
• C) Oliguria
• D) Blood in urine
• E) Fluid accumulation in renal pelvis
(2026) Actual Questions & Answers
(Concordia) 100% Guarantee Pass
SECTION 1: RENAL PATHOPHYSIOLOGY
1. A patient is suffering declining kidney function due to an autoimmune
disease. The patient asks the nurse how much of their kidney must suffer
damage to lead to end-stage renal disease (ESRD). Which of the following is the
appropriate response by the nurse?
• A) "Usually ESRD develops when less than 10% of the nephrons are
damaged."
• B) "Usually ESRD develops when 10% to 20% of the nephrons are
damaged."
• C) "Usually ESRD develops when 65% to 75% of the nephrons are
damaged."
• D) "Usually ESRD develops when 90% to 95% of the nephrons are
damaged."
Answer: D) "Usually ESRD develops when 90% to 95% of the nephrons are
damaged."
Rationale: The kidneys possess substantial functional reserve. Clinical
manifestations of renal failure typically do not appear until the glomerular
filtration rate (GFR) drops below 15–20 mL/min, which corresponds to the
destruction of approximately 90–95% of nephrons. At this stage, the remaining
nephrons cannot compensate through hyperfiltration, leading to uremic toxin
accumulation and the need for renal replacement therapy.
,2. A patient with severe renal failure may develop osteoporosis. Which factor
may play a role in this development?
• A) Kidneys are unable to activate vitamin D
• B) Kidneys are unable to activate vitamin C
• C) Renal patients must avoid the sunlight
• D) Kidneys are unable to synthesize erythropoietin
Answer: A) Kidneys are unable to activate vitamin D
Rationale: The kidneys perform the 1α-hydroxylation of 25-hydroxyvitamin D to its
active form, 1,25-dihydroxyvitamin D (calcitriol). In renal failure, this activation is
impaired, leading to hypocalcemia, secondary hyperparathyroidism, and renal
osteodystrophy, which includes osteoporosis and osteomalacia. Erythropoietin
deficiency causes anemia, not bone disease.
3. A patient with an obstruction of urine outflow anywhere distal to the renal
pelvis is experiencing which type of acute kidney injury?
• A) Prerenal
• B) Intrarenal
• C) Postrenal
• D) Juxtarenal
Answer: C) Postrenal
Rationale: Postrenal acute kidney injury is caused by obstruction of urine outflow
anywhere distal to the renal pelvis (ureter, bladder, urethra). Prerenal AKI involves
hypoperfusion (shock, dehydration). Intrarenal AKI involves parenchymal damage
(nephrotoxicity, glomerulonephritis). "Juxtarenal" is not a standard classification of
renal dysfunction.
,4. A nurse is evaluating a patient's risk for renal disorders. Which of the
following increase the risk for renal dysfunction? (Select all that apply)
• A) A patient with diabetes mellitus
• B) A patient with severe hypertension
• C) A patient with systemic lupus erythematosus
• D) A patient with cirrhosis
• E) A patient with peptic ulcer disease
Answer: A, B, C, and D
Rationale: Diabetes mellitus causes diabetic nephropathy through hyperglycemia-
induced glomerular hyperfiltration and basement membrane thickening. Severe
hypertension causes hypertensive nephrosclerosis. SLE causes immune complex-
mediated glomerulonephritis. Cirrhosis leads to hepatorenal syndrome and
functional renal failure through portal hypertension and splanchnic vasodilation.
Peptic ulcer disease does not directly impair renal function.
5. A female patient experiences urinary incontinence whenever she coughs or
sneezes. Otherwise, she states she has no urinary problems. What type of
incontinence is she experiencing?
• A) Neurogenic
• B) Overactive bladder
• C) Overflow
• D) Stress
Answer: D) Stress
Rationale: Stress urinary incontinence occurs when intra-abdominal pressure
exceeds urethral sphincter resistance during activities such as coughing, sneezing,
, laughing, or lifting. It results from pelvic floor weakness, urethral hypermobility, or
sphincter deficiency. Neurogenic incontinence involves neurologic disease.
Overactive bladder causes urgency and frequency. Overflow incontinence presents
with continuous dribbling from bladder distension and incomplete emptying.
6. A patient passes a kidney stone. What is the most likely composition of the
stone?
• A) Cystine
• B) Uric acid
• C) Calcium
• D) Magnesium
Answer: C) Calcium
Rationale: Calcium-containing stones (calcium oxalate and calcium phosphate)
account for approximately 80% of all kidney stones. They form in conditions of
hypercalciuria, hyperoxaluria, or hypocitraturia. Cystine stones occur only in
cystinuria (an autosomal recessive disorder). Uric acid stones comprise 5–10% and
form in acidic urine or gout. Magnesium is a stone inhibitor, not a primary stone
constituent.
7. Which of the following would alert the clinician that the patient may have
acute glomerulonephritis? (Select all that apply)
• A) Pain with urination
• B) Protein in urine
• C) Oliguria
• D) Blood in urine
• E) Fluid accumulation in renal pelvis
