401 Final Exam Study Guide
Questions with Actual Detailed
Answers 2026.
Nephrotic Syndrome
- assessments to be performed daily - Answer condition of increased glomerular
permeability; allows larger molecules to pass through the membrane into urine and be
excreted; most common cause - altered immunity with inflammation
massive loss of protein into urine [massive proteinuria], edema formation [especially facial and
periorbital], and decreased plasma albumin levels [hypoalbuminemia]
altered liver function may occur with NS, resulting in increased lipid production and
hyperlipidemia [+ lipiduria]
activation of RAAS --> Na retention
delayed clotting or increased bleeding with higher-than-normal values for serum activated aPTT
or INR, PT
reduced kidney function with elevated BUN and serum Cr and decreased GFR
treat underlying cause
immunosuppressant agents
ACEI can decreased protein loss in urine
cholesterol-lowering drugs
heparin may reduce vascular defects and improve kidney function
diet changes!!*** if GFR = decreased, then protein intake must be decreased, but if it is normal
then dietary intake of proteins is needed
mild diuretics and Na restriction to control edema and HTN
assess hydration status!! vascular dehydration is common and we want to maintain adequate
blood flow to the kidneys to avoid AKI
Diet appropriate for a oliguric, hypertensive patient with peripheral edema - Answer see
above
,Cystitis
- lab diagnostic information - Answer clean catch urine specimen (urinalysis culture and
sensitivity), serum WBC with differential - left shift, indicates that the # of immature WBCs is
increasing and mature #s are decreasing in response to continued infection, mostly occurs with
urosepsis because its systemic
+ leukocyte esterase and nitrate from a urinalysis
pyuria, hematuria, casts
more than 20 epithelial cells suggests contamination
if urinalysis suggests UTI, start treatment, but if it is complicated, then the second specimen is
analyzed as a urine culture [culture also done when UTI does not respond to usual therapy, dx is
uncertain, to assess for sensitivity, to determine resolution of UTI]
culture confirms type of organisms and # of colonies - ** UTI confirmed when >10 colony-
forming units/mL**
other diagnostic assessment - pelvic US or CT may be needed; cystoscopy
**for a patient with a cath that has been in place for > 2 weeks, it may be necessary to replace
the cath before obtaining urine specimen for culture**
read p. 1358
UTI prevention interventions with indwelling catheter usage - Answer Chart 66-7
p. 1356
Insert urinary catheters for appropriate use only! - acute urinary retention or bladder
obstruction, accurate measurement of urine volume in critically ill patients, perioperative
situations, to assist in healing of wounds in incontinent patients, potentially unstable spine
conditions or multiple injuries in which the patient requires immobilization, to provide comfort
at the end of life
remove them as soon as they can be removed!
ensure operation of systems remains closed, and without obstruction or backflow of urine!
avoid breaks in the system and replace if needed!
insert using sterile technique and clean aseptically!
more prevention - drink plenty of fluids [2-3 L daily if not contraindicated]; ensure adequate
sleep, rest, and nutrition daily to maintain immunologic health; consider another method of
contraception if spermicides are used; clean front to back; avoid irritation - douches, scented
, lubricants, bubble baths, tight-fitting underwear [wear loose-fitting cotton instead], scented
toilet tissue; women should empty bladder before and after intercourse, women and men
should both gently wash perineal area before intercourse; do not routinely delay urination;
notify provider right away of burning, frequency, difficulty esp those with chronic medical
conditions or those who are pregnant; consider taking cranberry substances (juices, capsules,
tablets) daily, avoiding high fructose juice; can apply topical estrogen to perineal area if
postmenopausal, which can normalize vaginal flora
Kidney Stones
- education to prevent further/complications of stones - Answer The most common
condition associated with kidney stone formation is dehydration.
Diet is NOT considered a risk factor for stones, however, a high intake of fluid & fruits and
veggies + low intake of protein + balanced intake of fats and carbs = prescribed to prevent and
treat recurrent urolithiasis. Ca+ and Vit D supplement and high-dose Vit C intake have been
implicated in stone formation.
High urine acidity or alkalinity, and drugs contribute to stone formation.
Urolithiasis and ureteral colic
- location of pain and symptoms - Answer Pain associated with kidney or ureteral irritation is
often severe and spasmodic.
Pain that radiates into the perineal area, groin, scrotum, or labia is described as renal colic,
which occurs with distention or spasm of the ureter.
Pain associated with ureteral spasms is excruciating and may cause the patient to go into shock
from stimulation of nearby nerves.
Renal colic pain may be intermittent or continuous and may occur with pallor, diaphoresis, and
hypotension.
Stones often do not cause sx until they pass into the lower urinary tract, where they can cause
excruciating pain; hematuria can occur; hydroureter can occur; urinary stasis can lead to
infection and impaired kidney function, and with persistent blockage, hydronephrosis can occur.
n/v
oliguria and anuria suggest obstruction...emergency!
frequency and dysuria - stone reaches bladder
elevated Vs with pain, possible infection, decreased BP with shock
CT scan
- medications/labs/allergies important for preparation - Answer some hospitals may require
patient to be NPO
may or may not be done using contrast medium
dye may be omitted in patients at risk for contrast-induced AKI
Questions with Actual Detailed
Answers 2026.
Nephrotic Syndrome
- assessments to be performed daily - Answer condition of increased glomerular
permeability; allows larger molecules to pass through the membrane into urine and be
excreted; most common cause - altered immunity with inflammation
massive loss of protein into urine [massive proteinuria], edema formation [especially facial and
periorbital], and decreased plasma albumin levels [hypoalbuminemia]
altered liver function may occur with NS, resulting in increased lipid production and
hyperlipidemia [+ lipiduria]
activation of RAAS --> Na retention
delayed clotting or increased bleeding with higher-than-normal values for serum activated aPTT
or INR, PT
reduced kidney function with elevated BUN and serum Cr and decreased GFR
treat underlying cause
immunosuppressant agents
ACEI can decreased protein loss in urine
cholesterol-lowering drugs
heparin may reduce vascular defects and improve kidney function
diet changes!!*** if GFR = decreased, then protein intake must be decreased, but if it is normal
then dietary intake of proteins is needed
mild diuretics and Na restriction to control edema and HTN
assess hydration status!! vascular dehydration is common and we want to maintain adequate
blood flow to the kidneys to avoid AKI
Diet appropriate for a oliguric, hypertensive patient with peripheral edema - Answer see
above
,Cystitis
- lab diagnostic information - Answer clean catch urine specimen (urinalysis culture and
sensitivity), serum WBC with differential - left shift, indicates that the # of immature WBCs is
increasing and mature #s are decreasing in response to continued infection, mostly occurs with
urosepsis because its systemic
+ leukocyte esterase and nitrate from a urinalysis
pyuria, hematuria, casts
more than 20 epithelial cells suggests contamination
if urinalysis suggests UTI, start treatment, but if it is complicated, then the second specimen is
analyzed as a urine culture [culture also done when UTI does not respond to usual therapy, dx is
uncertain, to assess for sensitivity, to determine resolution of UTI]
culture confirms type of organisms and # of colonies - ** UTI confirmed when >10 colony-
forming units/mL**
other diagnostic assessment - pelvic US or CT may be needed; cystoscopy
**for a patient with a cath that has been in place for > 2 weeks, it may be necessary to replace
the cath before obtaining urine specimen for culture**
read p. 1358
UTI prevention interventions with indwelling catheter usage - Answer Chart 66-7
p. 1356
Insert urinary catheters for appropriate use only! - acute urinary retention or bladder
obstruction, accurate measurement of urine volume in critically ill patients, perioperative
situations, to assist in healing of wounds in incontinent patients, potentially unstable spine
conditions or multiple injuries in which the patient requires immobilization, to provide comfort
at the end of life
remove them as soon as they can be removed!
ensure operation of systems remains closed, and without obstruction or backflow of urine!
avoid breaks in the system and replace if needed!
insert using sterile technique and clean aseptically!
more prevention - drink plenty of fluids [2-3 L daily if not contraindicated]; ensure adequate
sleep, rest, and nutrition daily to maintain immunologic health; consider another method of
contraception if spermicides are used; clean front to back; avoid irritation - douches, scented
, lubricants, bubble baths, tight-fitting underwear [wear loose-fitting cotton instead], scented
toilet tissue; women should empty bladder before and after intercourse, women and men
should both gently wash perineal area before intercourse; do not routinely delay urination;
notify provider right away of burning, frequency, difficulty esp those with chronic medical
conditions or those who are pregnant; consider taking cranberry substances (juices, capsules,
tablets) daily, avoiding high fructose juice; can apply topical estrogen to perineal area if
postmenopausal, which can normalize vaginal flora
Kidney Stones
- education to prevent further/complications of stones - Answer The most common
condition associated with kidney stone formation is dehydration.
Diet is NOT considered a risk factor for stones, however, a high intake of fluid & fruits and
veggies + low intake of protein + balanced intake of fats and carbs = prescribed to prevent and
treat recurrent urolithiasis. Ca+ and Vit D supplement and high-dose Vit C intake have been
implicated in stone formation.
High urine acidity or alkalinity, and drugs contribute to stone formation.
Urolithiasis and ureteral colic
- location of pain and symptoms - Answer Pain associated with kidney or ureteral irritation is
often severe and spasmodic.
Pain that radiates into the perineal area, groin, scrotum, or labia is described as renal colic,
which occurs with distention or spasm of the ureter.
Pain associated with ureteral spasms is excruciating and may cause the patient to go into shock
from stimulation of nearby nerves.
Renal colic pain may be intermittent or continuous and may occur with pallor, diaphoresis, and
hypotension.
Stones often do not cause sx until they pass into the lower urinary tract, where they can cause
excruciating pain; hematuria can occur; hydroureter can occur; urinary stasis can lead to
infection and impaired kidney function, and with persistent blockage, hydronephrosis can occur.
n/v
oliguria and anuria suggest obstruction...emergency!
frequency and dysuria - stone reaches bladder
elevated Vs with pain, possible infection, decreased BP with shock
CT scan
- medications/labs/allergies important for preparation - Answer some hospitals may require
patient to be NPO
may or may not be done using contrast medium
dye may be omitted in patients at risk for contrast-induced AKI
