, NURS 5461 EXAM 2
Adult Gerontology Primary Care
University of Texas at Arlington
100-Question Practice Examination
2026/2027 Edition
Renal & Urologic Disorders
1. In healthy aging, which renal change is most expected?
A) Gradual decline in GFR and concentrating ability
B) Progressive increase in GFR
C) Improved sodium conservation
D) Marked increase in renal mass
Correct Answer: A) Gradual decline in GFR and concentrating ability
Rationale: Aging is associated with reduced renal mass, renal blood flow, GFR, and concentrating/diluting reserve.
These changes increase vulnerability to volume disturbances and drug accumulation.
2. Why can a normal serum creatinine underestimate kidney dysfunction in an older adult?
A) Lower muscle mass may reduce creatinine production
B) Older adults excrete more creatinine
C) Creatinine is independent of muscle mass
D) GFR always increases with age
Correct Answer: A) Lower muscle mass may reduce creatinine production
Rationale: Serum creatinine reflects both production and filtration. Reduced muscle mass can keep serum creatinine
deceptively low despite reduced kidney function.
3. A rise in creatinine after starting an ACE inhibitor is particularly concerning for renal arterystenosis
when it reaches approximately what threshold?
A) 2% above baseline
B) 5% above baseline
C) 10% below baseline
D) About 30% above baseline
Correct Answer: D) About 30% above baseline
Rationale: A substantial creatinine rise after RAAS blockade can signal renovascular disease because filtration in a
stenotic kidney may depend on angiotensin II-mediated efferent arteriolar constriction.
4. Prerenal azotemia most directly results from what?
A) Immune glomerular injury
B) Reduced renal perfusion
C) Postrenal obstruction
D) Primary tubular necrosis
NURS 5461 Exam 2 | Adult Gerontology Primary Care | Original Practice Examination Page 1
, Correct Answer: B) Reduced renal perfusion
Rationale: Prerenal injury reflects reduced blood flow to otherwise structurally intact kidneys. Common causes
include dehydration, blood loss, low cardiac output, and systemic vasodilation.
5. Which urine sediment finding is classic for acute tubular necrosis?
A) Muddy brown granular casts
B) Fatty casts
C) Red-cell casts
D) White-cell casts only
Correct Answer: A) Muddy brown granular casts
Rationale: ATN causes tubular epithelial injury and sloughing, producing granular 'muddy brown' casts. The pattern
helps distinguish intrinsic tubular injury from prerenal azotemia.
6. A fractional excretion of sodium below 1% most strongly supports which condition in a
typicaluntreated patient?
A) Prerenal azotemia
B) Postrenal obstruction
C) Nephrotic syndrome
D) Acute tubular necrosis
Correct Answer: A) Prerenal azotemia
Rationale: With reduced perfusion and intact tubules, the kidney avidly conserves sodium. This often produces a low
FENa, although diuretics and CKD can alter interpretation.
7. Nephrotic syndrome is characterized by which core abnormality?
A) Severe hypernatremia
B) Isolated pyuria
C) Heavy proteinuria with hypoalbuminemia
D) Gross hematuria without proteinuria
Correct Answer: C) Heavy proteinuria with hypoalbuminemia
Rationale: Nephrotic syndrome causes marked glomerular protein loss, low serum albumin, edema, hyperlipidemia,
and increased thrombotic risk.
8. Why does edema develop in nephrotic syndrome?
A) Reduced plasma oncotic pressure plus renal sodium retention
B) Excess albumin production
C) Increased arterial oncotic pressure
D) Severe dehydration
Correct Answer: A) Reduced plasma oncotic pressure plus renal sodium retention
Rationale: Large urinary protein losses lower oncotic pressure and promote fluid movement into tissues.
Neurohormonal sodium retention further worsens edema.
9. Red blood cell casts are most suggestive of what?
NURS 5461 Exam 2 | Adult Gerontology Primary Care | Original Practice Examination Page 2
Adult Gerontology Primary Care
University of Texas at Arlington
100-Question Practice Examination
2026/2027 Edition
Renal & Urologic Disorders
1. In healthy aging, which renal change is most expected?
A) Gradual decline in GFR and concentrating ability
B) Progressive increase in GFR
C) Improved sodium conservation
D) Marked increase in renal mass
Correct Answer: A) Gradual decline in GFR and concentrating ability
Rationale: Aging is associated with reduced renal mass, renal blood flow, GFR, and concentrating/diluting reserve.
These changes increase vulnerability to volume disturbances and drug accumulation.
2. Why can a normal serum creatinine underestimate kidney dysfunction in an older adult?
A) Lower muscle mass may reduce creatinine production
B) Older adults excrete more creatinine
C) Creatinine is independent of muscle mass
D) GFR always increases with age
Correct Answer: A) Lower muscle mass may reduce creatinine production
Rationale: Serum creatinine reflects both production and filtration. Reduced muscle mass can keep serum creatinine
deceptively low despite reduced kidney function.
3. A rise in creatinine after starting an ACE inhibitor is particularly concerning for renal arterystenosis
when it reaches approximately what threshold?
A) 2% above baseline
B) 5% above baseline
C) 10% below baseline
D) About 30% above baseline
Correct Answer: D) About 30% above baseline
Rationale: A substantial creatinine rise after RAAS blockade can signal renovascular disease because filtration in a
stenotic kidney may depend on angiotensin II-mediated efferent arteriolar constriction.
4. Prerenal azotemia most directly results from what?
A) Immune glomerular injury
B) Reduced renal perfusion
C) Postrenal obstruction
D) Primary tubular necrosis
NURS 5461 Exam 2 | Adult Gerontology Primary Care | Original Practice Examination Page 1
, Correct Answer: B) Reduced renal perfusion
Rationale: Prerenal injury reflects reduced blood flow to otherwise structurally intact kidneys. Common causes
include dehydration, blood loss, low cardiac output, and systemic vasodilation.
5. Which urine sediment finding is classic for acute tubular necrosis?
A) Muddy brown granular casts
B) Fatty casts
C) Red-cell casts
D) White-cell casts only
Correct Answer: A) Muddy brown granular casts
Rationale: ATN causes tubular epithelial injury and sloughing, producing granular 'muddy brown' casts. The pattern
helps distinguish intrinsic tubular injury from prerenal azotemia.
6. A fractional excretion of sodium below 1% most strongly supports which condition in a
typicaluntreated patient?
A) Prerenal azotemia
B) Postrenal obstruction
C) Nephrotic syndrome
D) Acute tubular necrosis
Correct Answer: A) Prerenal azotemia
Rationale: With reduced perfusion and intact tubules, the kidney avidly conserves sodium. This often produces a low
FENa, although diuretics and CKD can alter interpretation.
7. Nephrotic syndrome is characterized by which core abnormality?
A) Severe hypernatremia
B) Isolated pyuria
C) Heavy proteinuria with hypoalbuminemia
D) Gross hematuria without proteinuria
Correct Answer: C) Heavy proteinuria with hypoalbuminemia
Rationale: Nephrotic syndrome causes marked glomerular protein loss, low serum albumin, edema, hyperlipidemia,
and increased thrombotic risk.
8. Why does edema develop in nephrotic syndrome?
A) Reduced plasma oncotic pressure plus renal sodium retention
B) Excess albumin production
C) Increased arterial oncotic pressure
D) Severe dehydration
Correct Answer: A) Reduced plasma oncotic pressure plus renal sodium retention
Rationale: Large urinary protein losses lower oncotic pressure and promote fluid movement into tissues.
Neurohormonal sodium retention further worsens edema.
9. Red blood cell casts are most suggestive of what?
NURS 5461 Exam 2 | Adult Gerontology Primary Care | Original Practice Examination Page 2
