NURSING PATHOPHYSIOLOGY EXAM #5A: ALTERATIONS IN KIDNEY & ELIMINATION
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Renal System & Urinary Elimination | Core
Domains: AKI, CKD, Glomerular Disorders, Obstructive Uropathies, and Fluid/Electrolyte/Acid-Base
Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment featuring comprehensive case studies
(e.g., progression of diabetic nephropathy to ESRD, prerenal AKI in heart failure) to evaluate
understanding of renal injury mechanisms and their systemic consequences.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that detail the
pathophysiological sequence from renal insult to loss of function and the resulting clinical and laboratory
profile presented in the case studies and questions.
Questions (55 Total)
1.
A patient develops acute kidney injury after receiving IV contrast. Urinalysis shows muddy brown
granular casts.
What is the diagnosis?
A. Prerenal azotemia
B. Acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Interstitial nephritis
ATN—the most common cause of intrinsic AKI—results from ischemia or nephrotoxins (e.g., contrast
dye). 'Muddy brown casts' are pathognomonic for tubular cell sloughing.
2.
A patient with long-standing diabetes has eGFR of 22 mL/min/1.73m², proteinuria, and anemia.
What stage of CKD is this?
,A. Stage 2
B. Stage 3b
C. Stage 4
D. Stage 5
CKD stages: Stage 1 (eGFR ≥90), Stage 2 (60–89), Stage 3a (45–59), Stage 3b (30–44), Stage 4 (15–29),
Stage 5 (<15 or dialysis). Stage 4 indicates severe kidney damage requiring nephrology referral.
3.
A child presents with periorbital edema, massive proteinuria (>3.5 g/day), hypoalbuminemia, and
hyperlipidemia.
What condition is present?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Pyelonephritis
D. UTI
Nephrotic syndrome features massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
Minimal change disease is the most common cause in children. Hematuria and RBC casts are absent.
4.
A patient with end-stage renal disease (ESRD) has serum potassium of 6.2 mEq/L, peaked T waves on
ECG, and muscle weakness.
What is the priority intervention?
A. Administer oral sodium polystyrene
B. Administer IV calcium gluconate, insulin/glucose, and albuterol
C. Restrict fluid intake
D. Give furosemide only
, Hyperkalemia >6.0 with ECG changes is life-threatening. IV calcium stabilizes the myocardium within
minutes. Insulin/glucose and albuterol shift K⁺ into cells. Kayexalate removes K⁺ but acts slowly.
5.
A patient with heart failure has BUN 45 mg/dL, creatinine 1.9 mg/dL, and BUN:Cr ratio of 24:1.
What type of AKI is most likely?
A. Intrinsic (ATN)
B. Prerenal azotemia
C. Postrenal obstruction
D. Glomerulonephritis
Prerenal AKI (e.g., from hypovolemia or low cardiac output) causes increased BUN reabsorption
relative to creatinine due to enhanced proximal tubule reabsorption, yielding a BUN:Cr ratio >20:1.
6.
A patient develops acute kidney injury after receiving IV contrast. Urinalysis shows muddy brown
granular casts.
What is the diagnosis?
A. Prerenal azotemia
B. Acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Interstitial nephritis
ATN—the most common cause of intrinsic AKI—results from ischemia or nephrotoxins (e.g., contrast
dye). 'Muddy brown casts' are pathognomonic for tubular cell sloughing.
7.
A patient with long-standing diabetes has eGFR of 22 mL/min/1.73m², proteinuria, and anemia.
What stage of CKD is this?
(2026/2027) | CASE STUDY & STANDARD QUESTIONS WITH CORRECT ANSWERS
Advanced Pathophysiology Examination: Focus on Renal System & Urinary Elimination | Core
Domains: AKI, CKD, Glomerular Disorders, Obstructive Uropathies, and Fluid/Electrolyte/Acid-Base
Imbalances | Graduate-Level Nursing Focus | Case Study & Clinical Application Exam Format
Exam Structure
This exam for the 2026/2027 cycle is a 55-question assessment featuring comprehensive case studies
(e.g., progression of diabetic nephropathy to ESRD, prerenal AKI in heart failure) to evaluate
understanding of renal injury mechanisms and their systemic consequences.
Answer Format
All correct answers must be presented in bold and green, followed by rationales that detail the
pathophysiological sequence from renal insult to loss of function and the resulting clinical and laboratory
profile presented in the case studies and questions.
Questions (55 Total)
1.
A patient develops acute kidney injury after receiving IV contrast. Urinalysis shows muddy brown
granular casts.
What is the diagnosis?
A. Prerenal azotemia
B. Acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Interstitial nephritis
ATN—the most common cause of intrinsic AKI—results from ischemia or nephrotoxins (e.g., contrast
dye). 'Muddy brown casts' are pathognomonic for tubular cell sloughing.
2.
A patient with long-standing diabetes has eGFR of 22 mL/min/1.73m², proteinuria, and anemia.
What stage of CKD is this?
,A. Stage 2
B. Stage 3b
C. Stage 4
D. Stage 5
CKD stages: Stage 1 (eGFR ≥90), Stage 2 (60–89), Stage 3a (45–59), Stage 3b (30–44), Stage 4 (15–29),
Stage 5 (<15 or dialysis). Stage 4 indicates severe kidney damage requiring nephrology referral.
3.
A child presents with periorbital edema, massive proteinuria (>3.5 g/day), hypoalbuminemia, and
hyperlipidemia.
What condition is present?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Pyelonephritis
D. UTI
Nephrotic syndrome features massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia.
Minimal change disease is the most common cause in children. Hematuria and RBC casts are absent.
4.
A patient with end-stage renal disease (ESRD) has serum potassium of 6.2 mEq/L, peaked T waves on
ECG, and muscle weakness.
What is the priority intervention?
A. Administer oral sodium polystyrene
B. Administer IV calcium gluconate, insulin/glucose, and albuterol
C. Restrict fluid intake
D. Give furosemide only
, Hyperkalemia >6.0 with ECG changes is life-threatening. IV calcium stabilizes the myocardium within
minutes. Insulin/glucose and albuterol shift K⁺ into cells. Kayexalate removes K⁺ but acts slowly.
5.
A patient with heart failure has BUN 45 mg/dL, creatinine 1.9 mg/dL, and BUN:Cr ratio of 24:1.
What type of AKI is most likely?
A. Intrinsic (ATN)
B. Prerenal azotemia
C. Postrenal obstruction
D. Glomerulonephritis
Prerenal AKI (e.g., from hypovolemia or low cardiac output) causes increased BUN reabsorption
relative to creatinine due to enhanced proximal tubule reabsorption, yielding a BUN:Cr ratio >20:1.
6.
A patient develops acute kidney injury after receiving IV contrast. Urinalysis shows muddy brown
granular casts.
What is the diagnosis?
A. Prerenal azotemia
B. Acute tubular necrosis (ATN)
C. Postrenal obstruction
D. Interstitial nephritis
ATN—the most common cause of intrinsic AKI—results from ischemia or nephrotoxins (e.g., contrast
dye). 'Muddy brown casts' are pathognomonic for tubular cell sloughing.
7.
A patient with long-standing diabetes has eGFR of 22 mL/min/1.73m², proteinuria, and anemia.
What stage of CKD is this?
