NURS 611 Exam 4 Focused Review: Renal, GI, Pulmonary, Reproductive, Endocrine, and Hematologic
Pathophysiology – 150 Practice Questions with Multiple Answers, Correct Choices, and Detailed
Explanations for Advanced Nursing Practice.
Renal & Urinary System (1–25)
1. Which findings are consistent with acute kidney injury (AKI) rather than chronic kidney disease
(CKD)? (Select all that apply)
A) Sudden onset over 48 hours
B) Small, shrunken kidneys on ultrasound
C) Normal kidney size
D) Anemia and hyperphosphatemia
E) Recent rise in serum creatinine
Correct Answers: A, C, E
Explanation: AKI presents acutely with normal kidney size; CKD shows small kidneys, anemia, and
chronic electrolyte abnormalities.
2. Which are risk factors for calcium oxalate kidney stones? (Select all that apply)
A) Hypercalciuria
B) Low urine volume
C) High dietary oxalate
D) Urinary pH >7.0
E) Low urine citrate
Correct Answers: A, B, C, E
Explanation: Hypercalciuria, low volume, high oxalate, and low citrate promote calcium oxalate stones.
Alkaline urine favors struvite stones.
3. Which clinical findings suggest pyelonephritis rather than cystitis? (Select all that apply)
A) Dysuria and frequency
B) Fever >38.3°C
C) Costovertebral angle tenderness
D) WBC casts in urine
E) Suprapubic pain
Correct Answers: B, C, D
Explanation: Fever, CVA tenderness, and WBC casts indicate upper tract infection (pyelonephritis).
Lower tract symptoms alone suggest cystitis.
4. Which are causes of prerenal AKI? (Select all that apply)
A) Severe dehydration
B) NSAID use
C) Acute tubular necrosis
,D) Cardiogenic shock
E) Bilateral ureteral obstruction
Correct Answers: A, B, D
Explanation: Prerenal causes reduce renal blood flow (hypovolemia, low cardiac output, afferent
arteriolar constriction). ATN is intrarenal; obstruction is postrenal.
5. Which lab abnormalities are found in nephrotic syndrome? (Select all that apply)
A) Proteinuria >3.5 g/24h
B) Hypoalbuminemia
C) Hyperlipidemia
D) Elevated serum complement
E) Peripheral edema
Correct Answers: A, B, C, E
Explanation: Nephrotic syndrome = massive proteinuria, hypoalbuminemia, hyperlipidemia, edema.
Complement is usually normal or low (e.g., lupus), not elevated.
6. Which are complications of end-stage renal disease (ESRD)? (Select all that apply)
A) Hyperkalemia
B) Metabolic alkalosis
C) Renal osteodystrophy
D) Uremic pericarditis
E) Anemia
Correct Answers: A, C, D, E
Explanation: ESRD causes hyperkalemia, metabolic acidosis (not alkalosis), bone disease, pericarditis,
and anemia (low EPO).
7. Which medications can cause acute interstitial nephritis (AIN)? (Select all that apply)
A) Penicillins
B) NSAIDs
C) Proton pump inhibitors
D) Loop diuretics
E) Acetaminophen
Correct Answers: A, B, C, D
Explanation: AIN is commonly drug-induced: beta-lactams, NSAIDs, PPIs, and diuretics.
Acetaminophen is a rare cause.
8. Which findings suggest diabetic nephropathy? (Select all that apply)
A) Microalbuminuria
B) Rapidly progressive glomerulonephritis
C) Nodular glomerulosclerosis (Kimmelstiel-Wilson)
D) Normal GFR until late stage
E) Red blood cell casts
,Correct Answers: A, C, D
Explanation: Diabetic nephropathy shows microalbuminuria, nodular sclerosis, and gradual GFR
decline. RBC casts suggest glomerulonephritis.
9. Which are first-line treatments for acute uncomplicated cystitis? (Select all that apply)
A) Nitrofurantoin
B) Trimethoprim-sulfamethoxazole (if susceptible)
C) Fosfomycin
D) IV vancomycin
E) Ciprofloxacin
Correct Answers: A, B, C
Explanation: First-line: nitrofurantoin, TMP-SMX (if local resistance <20%), fosfomycin.
Fluoroquinolones reserved for complicated cases.
10. Which are signs of uremia in CKD? (Select all that apply)
A) Pericardial friction rub
B) Asterixis
C) Metallic taste in mouth
D) Hyperreflexia
E) Uremic frost
Correct Answers: A, B, C, E
Explanation: Uremia causes pericarditis, asterixis, dysgeusia, and uremic frost. Hyporeflexia (not
hyperreflexia) occurs in advanced uremia.
11. Which are causes of postrenal AKI? (Select all that apply)
A) Benign prostatic hyperplasia
B) Bilateral ureteral stones
C) Severe hypotension
D) Retroperitoneal fibrosis
E) Acute glomerulonephritis
Correct Answers: A, B, D
Explanation: Postrenal AKI results from urinary tract obstruction (BPH, stones, fibrosis). Hypotension is
prerenal; glomerulonephritis is intrarenal.
12. Which lab findings are typical of acute glomerulonephritis? (Select all that apply)
A) Hematuria
B) Red blood cell casts
C) Azotemia
D) Low C3 complement
E) Massive proteinuria >3.5 g/day
Correct Answers: A, B, C, D
Explanation: Acute GN shows hematuria, RBC casts, azotemia, and often low C3. Nephrotic-range
proteinuria is not typical of acute GN.
, 13. Which are features of autosomal dominant polycystic kidney disease (ADPKD)? (Select all that
apply)
A) Hypertension
B) Hematuria
C) Liver cysts
D) Onset in infancy
E) Cerebral aneurysms
Correct Answers: A, B, C, E
Explanation: ADPKD presents in adulthood with hypertension, hematuria, liver cysts, and cerebral
aneurysms. Infantile onset suggests autosomal recessive PKD.
14. Which conditions cause hyperkalemia in renal failure? (Select all that apply)
A) Low GFR
B) ACE inhibitor use
C) Potassium-sparing diuretics
D) Metabolic acidosis
E) Loop diuretics
Correct Answers: A, B, C, D
Explanation: Hyperkalemia in renal failure is worsened by low GFR, ACEi/ARBs, K+-sparing diuretics,
and acidosis. Loop diuretics lower potassium.
15. Which are indications for initiating dialysis? (Select all that apply)
A) Uremic encephalopathy
B) Refractory hyperkalemia >6.5 mEq/L
C) Severe metabolic acidosis pH <7.1
D) Fluid overload with pulmonary edema
E) Asymptomatic creatinine >4 mg/dL
Correct Answers: A, B, C, D
Explanation: Dialysis indicated for uremic symptoms, severe hyperkalemia, intractable acidosis, or
volume overload—not creatinine level alone.
16. Which findings suggest renovascular hypertension? (Select all that apply)
A) Abdominal bruit
B) Flash pulmonary edema
C) Hypokalemia
D) Sudden onset hypertension in elderly
E) Normal renal ultrasound
Correct Answers: A, B, D
Explanation: Renovascular hypertension presents with abdominal bruit, flash pulmonary edema, and
sudden HTN in elderly. Hypokalemia suggests hyperaldosteronism.
17. Which are causes of nephrogenic diabetes insipidus? (Select all that apply)
A) Lithium therapy
B) Hypercalcemia
Pathophysiology – 150 Practice Questions with Multiple Answers, Correct Choices, and Detailed
Explanations for Advanced Nursing Practice.
Renal & Urinary System (1–25)
1. Which findings are consistent with acute kidney injury (AKI) rather than chronic kidney disease
(CKD)? (Select all that apply)
A) Sudden onset over 48 hours
B) Small, shrunken kidneys on ultrasound
C) Normal kidney size
D) Anemia and hyperphosphatemia
E) Recent rise in serum creatinine
Correct Answers: A, C, E
Explanation: AKI presents acutely with normal kidney size; CKD shows small kidneys, anemia, and
chronic electrolyte abnormalities.
2. Which are risk factors for calcium oxalate kidney stones? (Select all that apply)
A) Hypercalciuria
B) Low urine volume
C) High dietary oxalate
D) Urinary pH >7.0
E) Low urine citrate
Correct Answers: A, B, C, E
Explanation: Hypercalciuria, low volume, high oxalate, and low citrate promote calcium oxalate stones.
Alkaline urine favors struvite stones.
3. Which clinical findings suggest pyelonephritis rather than cystitis? (Select all that apply)
A) Dysuria and frequency
B) Fever >38.3°C
C) Costovertebral angle tenderness
D) WBC casts in urine
E) Suprapubic pain
Correct Answers: B, C, D
Explanation: Fever, CVA tenderness, and WBC casts indicate upper tract infection (pyelonephritis).
Lower tract symptoms alone suggest cystitis.
4. Which are causes of prerenal AKI? (Select all that apply)
A) Severe dehydration
B) NSAID use
C) Acute tubular necrosis
,D) Cardiogenic shock
E) Bilateral ureteral obstruction
Correct Answers: A, B, D
Explanation: Prerenal causes reduce renal blood flow (hypovolemia, low cardiac output, afferent
arteriolar constriction). ATN is intrarenal; obstruction is postrenal.
5. Which lab abnormalities are found in nephrotic syndrome? (Select all that apply)
A) Proteinuria >3.5 g/24h
B) Hypoalbuminemia
C) Hyperlipidemia
D) Elevated serum complement
E) Peripheral edema
Correct Answers: A, B, C, E
Explanation: Nephrotic syndrome = massive proteinuria, hypoalbuminemia, hyperlipidemia, edema.
Complement is usually normal or low (e.g., lupus), not elevated.
6. Which are complications of end-stage renal disease (ESRD)? (Select all that apply)
A) Hyperkalemia
B) Metabolic alkalosis
C) Renal osteodystrophy
D) Uremic pericarditis
E) Anemia
Correct Answers: A, C, D, E
Explanation: ESRD causes hyperkalemia, metabolic acidosis (not alkalosis), bone disease, pericarditis,
and anemia (low EPO).
7. Which medications can cause acute interstitial nephritis (AIN)? (Select all that apply)
A) Penicillins
B) NSAIDs
C) Proton pump inhibitors
D) Loop diuretics
E) Acetaminophen
Correct Answers: A, B, C, D
Explanation: AIN is commonly drug-induced: beta-lactams, NSAIDs, PPIs, and diuretics.
Acetaminophen is a rare cause.
8. Which findings suggest diabetic nephropathy? (Select all that apply)
A) Microalbuminuria
B) Rapidly progressive glomerulonephritis
C) Nodular glomerulosclerosis (Kimmelstiel-Wilson)
D) Normal GFR until late stage
E) Red blood cell casts
,Correct Answers: A, C, D
Explanation: Diabetic nephropathy shows microalbuminuria, nodular sclerosis, and gradual GFR
decline. RBC casts suggest glomerulonephritis.
9. Which are first-line treatments for acute uncomplicated cystitis? (Select all that apply)
A) Nitrofurantoin
B) Trimethoprim-sulfamethoxazole (if susceptible)
C) Fosfomycin
D) IV vancomycin
E) Ciprofloxacin
Correct Answers: A, B, C
Explanation: First-line: nitrofurantoin, TMP-SMX (if local resistance <20%), fosfomycin.
Fluoroquinolones reserved for complicated cases.
10. Which are signs of uremia in CKD? (Select all that apply)
A) Pericardial friction rub
B) Asterixis
C) Metallic taste in mouth
D) Hyperreflexia
E) Uremic frost
Correct Answers: A, B, C, E
Explanation: Uremia causes pericarditis, asterixis, dysgeusia, and uremic frost. Hyporeflexia (not
hyperreflexia) occurs in advanced uremia.
11. Which are causes of postrenal AKI? (Select all that apply)
A) Benign prostatic hyperplasia
B) Bilateral ureteral stones
C) Severe hypotension
D) Retroperitoneal fibrosis
E) Acute glomerulonephritis
Correct Answers: A, B, D
Explanation: Postrenal AKI results from urinary tract obstruction (BPH, stones, fibrosis). Hypotension is
prerenal; glomerulonephritis is intrarenal.
12. Which lab findings are typical of acute glomerulonephritis? (Select all that apply)
A) Hematuria
B) Red blood cell casts
C) Azotemia
D) Low C3 complement
E) Massive proteinuria >3.5 g/day
Correct Answers: A, B, C, D
Explanation: Acute GN shows hematuria, RBC casts, azotemia, and often low C3. Nephrotic-range
proteinuria is not typical of acute GN.
, 13. Which are features of autosomal dominant polycystic kidney disease (ADPKD)? (Select all that
apply)
A) Hypertension
B) Hematuria
C) Liver cysts
D) Onset in infancy
E) Cerebral aneurysms
Correct Answers: A, B, C, E
Explanation: ADPKD presents in adulthood with hypertension, hematuria, liver cysts, and cerebral
aneurysms. Infantile onset suggests autosomal recessive PKD.
14. Which conditions cause hyperkalemia in renal failure? (Select all that apply)
A) Low GFR
B) ACE inhibitor use
C) Potassium-sparing diuretics
D) Metabolic acidosis
E) Loop diuretics
Correct Answers: A, B, C, D
Explanation: Hyperkalemia in renal failure is worsened by low GFR, ACEi/ARBs, K+-sparing diuretics,
and acidosis. Loop diuretics lower potassium.
15. Which are indications for initiating dialysis? (Select all that apply)
A) Uremic encephalopathy
B) Refractory hyperkalemia >6.5 mEq/L
C) Severe metabolic acidosis pH <7.1
D) Fluid overload with pulmonary edema
E) Asymptomatic creatinine >4 mg/dL
Correct Answers: A, B, C, D
Explanation: Dialysis indicated for uremic symptoms, severe hyperkalemia, intractable acidosis, or
volume overload—not creatinine level alone.
16. Which findings suggest renovascular hypertension? (Select all that apply)
A) Abdominal bruit
B) Flash pulmonary edema
C) Hypokalemia
D) Sudden onset hypertension in elderly
E) Normal renal ultrasound
Correct Answers: A, B, D
Explanation: Renovascular hypertension presents with abdominal bruit, flash pulmonary edema, and
sudden HTN in elderly. Hypokalemia suggests hyperaldosteronism.
17. Which are causes of nephrogenic diabetes insipidus? (Select all that apply)
A) Lithium therapy
B) Hypercalcemia
