NURS 611 Exam 4 Advanced Pathophysiology: Renal, GI, Pulmonary, Endocrine, Reproductive,
Hematology, Immunology – 150 Master Questions with Multiple Correct Answers, Rationales, and Clinical
Pearls.
Renal & Urinary System (1–30)
1. Which findings are characteristic of acute kidney injury (AKI) rather than chronic kidney disease
(CKD)?
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?
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?
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. Lower tract
symptoms alone suggest cystitis.
4. Which are causes of prerenal AKI?
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
constriction). ATN is intrarenal; obstruction is postrenal.
5. Which lab abnormalities are found in nephrotic syndrome?
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.
6. Which are complications of end-stage renal disease (ESRD)?
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)?
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?
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?
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?
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?
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?
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.
, 13. Which are features of autosomal dominant polycystic kidney disease (ADPKD)?
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 recessive PKD.
14. Which conditions cause hyperkalemia in renal failure?
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 worsened by low GFR, ACEi/ARBs, K+-sparing diuretics, and acidosis. Loop
diuretics lower potassium.
15. Which are indications for initiating dialysis?
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?
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: abdominal bruit, flash pulmonary edema, sudden HTN in
elderly. Hypokalemia suggests hyperaldosteronism.
17. Which are causes of nephrogenic diabetes insipidus?
A) Lithium therapy
B) Hypercalcemia
C) Hypokalemia
Hematology, Immunology – 150 Master Questions with Multiple Correct Answers, Rationales, and Clinical
Pearls.
Renal & Urinary System (1–30)
1. Which findings are characteristic of acute kidney injury (AKI) rather than chronic kidney disease
(CKD)?
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?
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?
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. Lower tract
symptoms alone suggest cystitis.
4. Which are causes of prerenal AKI?
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
constriction). ATN is intrarenal; obstruction is postrenal.
5. Which lab abnormalities are found in nephrotic syndrome?
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.
6. Which are complications of end-stage renal disease (ESRD)?
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)?
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?
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?
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?
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?
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?
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.
, 13. Which are features of autosomal dominant polycystic kidney disease (ADPKD)?
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 recessive PKD.
14. Which conditions cause hyperkalemia in renal failure?
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 worsened by low GFR, ACEi/ARBs, K+-sparing diuretics, and acidosis. Loop
diuretics lower potassium.
15. Which are indications for initiating dialysis?
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?
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: abdominal bruit, flash pulmonary edema, sudden HTN in
elderly. Hypokalemia suggests hyperaldosteronism.
17. Which are causes of nephrogenic diabetes insipidus?
A) Lithium therapy
B) Hypercalcemia
C) Hypokalemia
