NUR 442 Exam with Accurate Answers. Latest
Edition
The nurse is examining the patient's urinalysis and notices the presence of red blood cells and
albumin as well as nitrogenous waste products and sodium. The nurse realizes that:
A. red blood cells are normally found in urine.
B. albumin is an abnormal finding in urine.
C. urinary sodium levels should be higher than serum levels.
D. nitrogenous waste products in urine indicate kidney disease. - ✔✔B. albumin is an abnormal
finding in urine.
Rationale:
(Normal glomerular filtrate is basically protein free and contains electrolytes, including sodium,
chloride, and phosphate, and nitrogenous waste products, such as creatinine, urea, and uric
acid, in amounts similar to those in plasma. Red blood cells, albumin, and globulin are too large
to pass through the healthy glomerular membrane.)
The nurse is caring for a patient who is 90 years old. The patient's creatinine level is within
normal limits. The nurse understands that the reason for the normal value is:
A. renal blood flow remains constant throughout life.
B. the number of glomeruli increases with collateral circulation.
C. serum creatinine levels may remain the same in the elderly.
D. peritubular density increases as glomeruli decrease in number. - ✔✔C. serum creatinine
levels may remain the same in the elderly.
Rationale:
(After age 40, renal blood flow gradually diminishes at a rate of 10% per decade. With
advancing age, there is also a decrease in renal mass, number of glomeruli, and peritubular
,density. Serum creatinine levels may remain the same in the elderly patient even with a
declining glomerular filtration rate (GFR) because of decreased muscle mass and hence
decreased creatinine production.)
A 53-year-old patient has kidney and ureteral stones and is hospitalized for urinary retention
and severe flank pain. What classification of acute kidney injury is the patient in danger of
developing?
A. Acute tubular necrosis
B. Intrarenal
C. Postrenal
D. Prerenal - ✔✔C. Postrenal
Rationale:
(The etiology of acute kidney injury (AKI) is classified as prerenal, postrenal, or intrarenal.
Classification depends on where the precipitating factor exerts its pathophysiological effect on
the kidney. Acute kidney injury resulting from obstruction of the flow of urine is classified as
postrenal, or obstructive renal injury. Obstruction can occur at any point along the urinary
system. Conditions that result in AKI by interfering with renal perfusion are classified as
prerenal. Most prerenal causes of AKI are related to intravascular volume depletion, decreased
cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation
and GFR. These conditions reduce the glomerular perfusion and the GFR, and the kidneys are
hypoperfused. Conditions that produce AKI by directly acting on functioning kidney tissue
(either the glomerulus or the renal tubules) are classified as intrarenal. The most common
intrarenal condition is acute tubular necrosis (ATN).)
Decreased blood flow through the kidney results in:
A. decreased systolic blood pressure.
B. increased excretion of sodium and water.
C. peripheral vasodilation.
D. release of renin from the kidney. - ✔✔D. release of renin from the kidney.
, Rationale:
(Renin is released whenever blood flow through the afferent and efferent arterioles decreases.
A decrease in the sodium ion concentration of the blood flowing past the specialized cells (e.g.,
in hypovolemia) also stimulates the release of renin. Renin activates the renin-angiotensin-
aldosterone cascade, which ultimately results in angiotensin II production. Angiotensin II causes
vasoconstriction and release of aldosterone from the adrenal glands, thereby raising blood
pressure, increasing blood flow, and increasing sodium and water reabsorption in the distal
tubule and collecting ducts.)
The nurse is caring for a patient who weighs 70 kg. For this patient, oliguria is defined as urine
output that is _____ mL per hour.
A. greater than 35
B. less than 50
C. less than 100
D. less than 35 - ✔✔D. less than 35
Rationale:
(Oliguria is defined as urine output less than 0.5 mL/kg/hr. For a 70-kg patient, the minimal
expected urine output is at least 35 mL/hr (0.5 mL × 70 kg).)
During the maintenance phase of intrinsic renal failure, which of the following abnormalities
are likely?
A. Infection, hypokalemia, hyponatremia
B. Oliguria, azotemia, hyperkalemia
C. Oliguria, hypokalemia, hypernatremia
D. Uremia, hyperkalemia, infection - ✔✔D. Uremia, hyperkalemia, infection
Edition
The nurse is examining the patient's urinalysis and notices the presence of red blood cells and
albumin as well as nitrogenous waste products and sodium. The nurse realizes that:
A. red blood cells are normally found in urine.
B. albumin is an abnormal finding in urine.
C. urinary sodium levels should be higher than serum levels.
D. nitrogenous waste products in urine indicate kidney disease. - ✔✔B. albumin is an abnormal
finding in urine.
Rationale:
(Normal glomerular filtrate is basically protein free and contains electrolytes, including sodium,
chloride, and phosphate, and nitrogenous waste products, such as creatinine, urea, and uric
acid, in amounts similar to those in plasma. Red blood cells, albumin, and globulin are too large
to pass through the healthy glomerular membrane.)
The nurse is caring for a patient who is 90 years old. The patient's creatinine level is within
normal limits. The nurse understands that the reason for the normal value is:
A. renal blood flow remains constant throughout life.
B. the number of glomeruli increases with collateral circulation.
C. serum creatinine levels may remain the same in the elderly.
D. peritubular density increases as glomeruli decrease in number. - ✔✔C. serum creatinine
levels may remain the same in the elderly.
Rationale:
(After age 40, renal blood flow gradually diminishes at a rate of 10% per decade. With
advancing age, there is also a decrease in renal mass, number of glomeruli, and peritubular
,density. Serum creatinine levels may remain the same in the elderly patient even with a
declining glomerular filtration rate (GFR) because of decreased muscle mass and hence
decreased creatinine production.)
A 53-year-old patient has kidney and ureteral stones and is hospitalized for urinary retention
and severe flank pain. What classification of acute kidney injury is the patient in danger of
developing?
A. Acute tubular necrosis
B. Intrarenal
C. Postrenal
D. Prerenal - ✔✔C. Postrenal
Rationale:
(The etiology of acute kidney injury (AKI) is classified as prerenal, postrenal, or intrarenal.
Classification depends on where the precipitating factor exerts its pathophysiological effect on
the kidney. Acute kidney injury resulting from obstruction of the flow of urine is classified as
postrenal, or obstructive renal injury. Obstruction can occur at any point along the urinary
system. Conditions that result in AKI by interfering with renal perfusion are classified as
prerenal. Most prerenal causes of AKI are related to intravascular volume depletion, decreased
cardiac output, renal vasoconstriction, or pharmacological agents that impair autoregulation
and GFR. These conditions reduce the glomerular perfusion and the GFR, and the kidneys are
hypoperfused. Conditions that produce AKI by directly acting on functioning kidney tissue
(either the glomerulus or the renal tubules) are classified as intrarenal. The most common
intrarenal condition is acute tubular necrosis (ATN).)
Decreased blood flow through the kidney results in:
A. decreased systolic blood pressure.
B. increased excretion of sodium and water.
C. peripheral vasodilation.
D. release of renin from the kidney. - ✔✔D. release of renin from the kidney.
, Rationale:
(Renin is released whenever blood flow through the afferent and efferent arterioles decreases.
A decrease in the sodium ion concentration of the blood flowing past the specialized cells (e.g.,
in hypovolemia) also stimulates the release of renin. Renin activates the renin-angiotensin-
aldosterone cascade, which ultimately results in angiotensin II production. Angiotensin II causes
vasoconstriction and release of aldosterone from the adrenal glands, thereby raising blood
pressure, increasing blood flow, and increasing sodium and water reabsorption in the distal
tubule and collecting ducts.)
The nurse is caring for a patient who weighs 70 kg. For this patient, oliguria is defined as urine
output that is _____ mL per hour.
A. greater than 35
B. less than 50
C. less than 100
D. less than 35 - ✔✔D. less than 35
Rationale:
(Oliguria is defined as urine output less than 0.5 mL/kg/hr. For a 70-kg patient, the minimal
expected urine output is at least 35 mL/hr (0.5 mL × 70 kg).)
During the maintenance phase of intrinsic renal failure, which of the following abnormalities
are likely?
A. Infection, hypokalemia, hyponatremia
B. Oliguria, azotemia, hyperkalemia
C. Oliguria, hypokalemia, hypernatremia
D. Uremia, hyperkalemia, infection - ✔✔D. Uremia, hyperkalemia, infection
