1
NSG 3850 exam 3 Patho II (ACTUAL EXAM SIMULATION
WITH NGN) 130 QUESTIONS WITH VERIFIED ANSWERS
AND COMPREHENSIVE RATIONALES
Section 1: Renal Disorders (Nephrology)
Q1. A patient's urinalysis shows massive proteinuria (>3.5 g/day), hypoalbuminemia, and generalized
edema. Which of the following findings is NOT typically associated with this condition?
A. Hyperlipidemia
B. Hematuria
C. Increased risk of infection
D. Hypercoagulability
Answer: B
Rationale: This patient presentation is classic for Nephrotic Syndrome. The key features are massive
proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria. Hematuria (blood in the urine) is
a hallmark of Nephritic Syndrome, not Nephrotic. In Nephrotic Syndrome, damage to the glomerular
basement membrane allows protein, but not large amounts of red blood cells, to leak into the urine.
Q2. A patient with acute post-streptococcal glomerulonephritis is most likely to have which description
of their urine?
A. Clear and dilute
B. Dark, "smoky," "cola," or "coffee-colored"
C. Foul-smelling and cloudy
D. Bright yellow with a fruity odor
Answer: B
Rationale: The hematuria caused by inflammation of the glomeruli in post-streptococcal
glomerulonephritis gives the urine a characteristic dark, "smoky," "cola," or "coffee-colored"
appearance. The presence of red blood cell casts is a classic finding.
Q3. A patient presents with a high fever, chills, nausea, and flank pain. Urinalysis shows pyuria (WBCs)
and bacteriuria. The nurse recognizes this as a classic presentation of:
A. Nephrotic syndrome
B. Acute pyelonephritis
C. Renal calculi
D. Acute kidney injury
,2
Answer: B
Rationale: Acute pyelonephritis is an infection of the renal pelvis and kidney parenchyma. Its classic
signs are fever, chills, and flank pain (often described as costovertebral angle, or CVA, tenderness).
Q4. What is the most common causative organism for acute pyelonephritis?
A. Streptococcus
B. Escherichia coli (E. coli)
C. Klebsiella
D. Enterobacter
Answer: B
Rationale: Escherichia coli is the most common pathogen in both uncomplicated lower urinary tract
infections (UTIs) and acute pyelonephritis. It ascends from the perineum to the bladder and then to the
kidneys.
Q5. Which of the following is the major modifiable risk factor for developing nephrolithiasis (kidney
stones)?
A. Positive family history
B. Dehydration
C. Being male
D. Advanced age
Answer: B
Rationale: While a family history, being male, and age are non-modifiable risk factors, dehydration is the
most significant modifiable risk. Concentrated urine promotes the supersaturation and crystallization of
stone-forming salts.
Q6. The most common type of renal calculus (kidney stone) is composed of:
A. Uric acid
B. Calcium (oxalate or phosphate)
C. Struvite
D. Cystine
Answer: B
Rationale: Calcium stones, primarily calcium oxalate, account for approximately 75-85% of all kidney
stones. They are often associated with hypercalciuria (excess calcium in the urine).
Q7. A patient with polycystic kidney disease (PKD) should be monitored for the development of
aneurysms and cysts in which other organ?
A. Lungs
B. Liver
,3
C. Spleen
D. Pancreas
Answer: B
Rationale: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder that frequently
leads to hepatic cysts and an increased risk of berry aneurysms in the cerebral circulation. Monitoring
for these complications is a key part of long-term management.
Q8. Which of the following accurately describes the pathophysiologic basis of acute post-streptococcal
glomerulonephritis?
A. Direct bacterial invasion of the kidney parenchyma
B. An immune complex reaction causing inflammation of the glomeruli
C. Renal ischemia secondary to hypotension
D. Anaphylactic reaction to the bacteria
Answer: B
Rationale: This condition is a classic example of a Type III hypersensitivity reaction. Immune complexes
(antigen-antibody) formed in response to a Group A Streptococcus infection become lodged in the
glomerular basement membrane, activating the complement system and causing inflammation and
damage.
Q9. A patient's lab work shows a sudden increase in serum creatinine and a decrease in urine output.
The provider suspects heart failure is the cause of the renal dysfunction. This would be classified as
which type of Acute Kidney Injury (AKI)?
A. Prerenal
B. Intrinsic (Intrarenal)
C. Postrenal
D. Anuric
Answer: A
Rationale: Prerenal AKI is caused by a decrease in blood flow to the kidneys. Heart failure, shock, and
severe dehydration are all examples of prerenal causes. In this case, the kidneys themselves are not
initially damaged; they are just not receiving enough perfusion.
Q10. A patient with nephrotic syndrome asks, "Why is my urine so foamy?" The nurse's best response is
based on the knowledge that:
A. "You are likely not drinking enough fluids."
B. "The inflammation in your kidneys is causing blood to leak out."
C. "Large amounts of protein are leaking from damaged glomeruli into your urine."
D. "This is a sign of a bacterial infection in your bladder."
Answer: C
Rationale: The foamy appearance of urine in nephrotic syndrome is due to the massive proteinuria.
, 4
Damage to the podocytes and glomerular basement membrane allows large proteins like albumin to
escape into the filtrate, which changes the surface tension of the urine and creates foam.
Q11. Hyperlipidemia occurs in nephrotic syndrome primarily because:
A. Lipids are not excreted in the urine
B. The liver compensates for protein loss by increasing lipoprotein synthesis
C. Body fats are rapidly catabolized for energy
D. Muscles stop using triglycerides as fuel
Answer: B
Rationale: The loss of protein (specifically albumin) in the urine leads to hypoalbuminemia. This triggers
a compensatory response in the liver to increase the synthesis of proteins, but it also increases the
synthesis of lipoproteins, leading to hyperlipidemia.
Q12. Which type of incontinence is described as a sudden, intense urge to urinate followed by an
involuntary loss of urine, often associated with an overactive bladder?
A. Stress incontinence
B. Overflow incontinence
C. Urge incontinence
D. Functional incontinence
Answer: C
Rationale: Urge incontinence is characterized by a strong, sudden need to urinate (urgency) that is
difficult to delay, leading to an involuntary loss of urine. It is a hallmark of an overactive bladder.
Section 2: Gastrointestinal (GI) Disorders
Q13. What type of diarrhea is caused by an increased amount of poorly absorbed solutes in the
intestine, which draws water into the bowel lumen?
A. Secretory diarrhea
B. Osmotic diarrhea
C. Exudative diarrhea
D. Motility diarrhea
Answer: B
Rationale: Osmotic diarrhea occurs when non-absorbable substances (e.g., lactose in lactose
intolerance, magnesium in some antacids) remain in the intestine. These solutes create an osmotic
gradient that pulls water into the bowel, resulting in loose stools.
Q14. A patient with chronic liver disease develops ascites and esophageal varices. The primary
pathophysiologic process underlying these complications is:
A. Decreased hepatic blood flow
NSG 3850 exam 3 Patho II (ACTUAL EXAM SIMULATION
WITH NGN) 130 QUESTIONS WITH VERIFIED ANSWERS
AND COMPREHENSIVE RATIONALES
Section 1: Renal Disorders (Nephrology)
Q1. A patient's urinalysis shows massive proteinuria (>3.5 g/day), hypoalbuminemia, and generalized
edema. Which of the following findings is NOT typically associated with this condition?
A. Hyperlipidemia
B. Hematuria
C. Increased risk of infection
D. Hypercoagulability
Answer: B
Rationale: This patient presentation is classic for Nephrotic Syndrome. The key features are massive
proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria. Hematuria (blood in the urine) is
a hallmark of Nephritic Syndrome, not Nephrotic. In Nephrotic Syndrome, damage to the glomerular
basement membrane allows protein, but not large amounts of red blood cells, to leak into the urine.
Q2. A patient with acute post-streptococcal glomerulonephritis is most likely to have which description
of their urine?
A. Clear and dilute
B. Dark, "smoky," "cola," or "coffee-colored"
C. Foul-smelling and cloudy
D. Bright yellow with a fruity odor
Answer: B
Rationale: The hematuria caused by inflammation of the glomeruli in post-streptococcal
glomerulonephritis gives the urine a characteristic dark, "smoky," "cola," or "coffee-colored"
appearance. The presence of red blood cell casts is a classic finding.
Q3. A patient presents with a high fever, chills, nausea, and flank pain. Urinalysis shows pyuria (WBCs)
and bacteriuria. The nurse recognizes this as a classic presentation of:
A. Nephrotic syndrome
B. Acute pyelonephritis
C. Renal calculi
D. Acute kidney injury
,2
Answer: B
Rationale: Acute pyelonephritis is an infection of the renal pelvis and kidney parenchyma. Its classic
signs are fever, chills, and flank pain (often described as costovertebral angle, or CVA, tenderness).
Q4. What is the most common causative organism for acute pyelonephritis?
A. Streptococcus
B. Escherichia coli (E. coli)
C. Klebsiella
D. Enterobacter
Answer: B
Rationale: Escherichia coli is the most common pathogen in both uncomplicated lower urinary tract
infections (UTIs) and acute pyelonephritis. It ascends from the perineum to the bladder and then to the
kidneys.
Q5. Which of the following is the major modifiable risk factor for developing nephrolithiasis (kidney
stones)?
A. Positive family history
B. Dehydration
C. Being male
D. Advanced age
Answer: B
Rationale: While a family history, being male, and age are non-modifiable risk factors, dehydration is the
most significant modifiable risk. Concentrated urine promotes the supersaturation and crystallization of
stone-forming salts.
Q6. The most common type of renal calculus (kidney stone) is composed of:
A. Uric acid
B. Calcium (oxalate or phosphate)
C. Struvite
D. Cystine
Answer: B
Rationale: Calcium stones, primarily calcium oxalate, account for approximately 75-85% of all kidney
stones. They are often associated with hypercalciuria (excess calcium in the urine).
Q7. A patient with polycystic kidney disease (PKD) should be monitored for the development of
aneurysms and cysts in which other organ?
A. Lungs
B. Liver
,3
C. Spleen
D. Pancreas
Answer: B
Rationale: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder that frequently
leads to hepatic cysts and an increased risk of berry aneurysms in the cerebral circulation. Monitoring
for these complications is a key part of long-term management.
Q8. Which of the following accurately describes the pathophysiologic basis of acute post-streptococcal
glomerulonephritis?
A. Direct bacterial invasion of the kidney parenchyma
B. An immune complex reaction causing inflammation of the glomeruli
C. Renal ischemia secondary to hypotension
D. Anaphylactic reaction to the bacteria
Answer: B
Rationale: This condition is a classic example of a Type III hypersensitivity reaction. Immune complexes
(antigen-antibody) formed in response to a Group A Streptococcus infection become lodged in the
glomerular basement membrane, activating the complement system and causing inflammation and
damage.
Q9. A patient's lab work shows a sudden increase in serum creatinine and a decrease in urine output.
The provider suspects heart failure is the cause of the renal dysfunction. This would be classified as
which type of Acute Kidney Injury (AKI)?
A. Prerenal
B. Intrinsic (Intrarenal)
C. Postrenal
D. Anuric
Answer: A
Rationale: Prerenal AKI is caused by a decrease in blood flow to the kidneys. Heart failure, shock, and
severe dehydration are all examples of prerenal causes. In this case, the kidneys themselves are not
initially damaged; they are just not receiving enough perfusion.
Q10. A patient with nephrotic syndrome asks, "Why is my urine so foamy?" The nurse's best response is
based on the knowledge that:
A. "You are likely not drinking enough fluids."
B. "The inflammation in your kidneys is causing blood to leak out."
C. "Large amounts of protein are leaking from damaged glomeruli into your urine."
D. "This is a sign of a bacterial infection in your bladder."
Answer: C
Rationale: The foamy appearance of urine in nephrotic syndrome is due to the massive proteinuria.
, 4
Damage to the podocytes and glomerular basement membrane allows large proteins like albumin to
escape into the filtrate, which changes the surface tension of the urine and creates foam.
Q11. Hyperlipidemia occurs in nephrotic syndrome primarily because:
A. Lipids are not excreted in the urine
B. The liver compensates for protein loss by increasing lipoprotein synthesis
C. Body fats are rapidly catabolized for energy
D. Muscles stop using triglycerides as fuel
Answer: B
Rationale: The loss of protein (specifically albumin) in the urine leads to hypoalbuminemia. This triggers
a compensatory response in the liver to increase the synthesis of proteins, but it also increases the
synthesis of lipoproteins, leading to hyperlipidemia.
Q12. Which type of incontinence is described as a sudden, intense urge to urinate followed by an
involuntary loss of urine, often associated with an overactive bladder?
A. Stress incontinence
B. Overflow incontinence
C. Urge incontinence
D. Functional incontinence
Answer: C
Rationale: Urge incontinence is characterized by a strong, sudden need to urinate (urgency) that is
difficult to delay, leading to an involuntary loss of urine. It is a hallmark of an overactive bladder.
Section 2: Gastrointestinal (GI) Disorders
Q13. What type of diarrhea is caused by an increased amount of poorly absorbed solutes in the
intestine, which draws water into the bowel lumen?
A. Secretory diarrhea
B. Osmotic diarrhea
C. Exudative diarrhea
D. Motility diarrhea
Answer: B
Rationale: Osmotic diarrhea occurs when non-absorbable substances (e.g., lactose in lactose
intolerance, magnesium in some antacids) remain in the intestine. These solutes create an osmotic
gradient that pulls water into the bowel, resulting in loose stools.
Q14. A patient with chronic liver disease develops ascites and esophageal varices. The primary
pathophysiologic process underlying these complications is:
A. Decreased hepatic blood flow
