NUR 376 Exam 4 V2 | NUR 376 Applied
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 4) | Concordia
1. A patient is diagnosed with Acute Kidney Injury (AKI) in the prerenal stage. Which of the
following pathophysiological mechanisms is primarily responsible for this condition?
A. Direct damage to the renal parenchyma
B. Obstruction of the urinary tract outflow
C. Nephrotoxic injury to the basement membrane
D. Reduced renal blood flow leading to decreased glomerular perfusion
Correct Answer: D
Prerenal AKI is caused by factors that reduce systemic circulation, causing a decrease in
renal blood flow. This leads to a reduction in glomerular filtration rate as the kidneys are
not being adequately perfused. Common causes include dehydration, heart failure, or
decreased cardiac output.
2. A client is admitted with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
serum laboratory value is the nurse most likely to find?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Serum potassium 5.8 mEq/L
,D. Serum calcium 11.5 mg/dL
Correct Answer: B
SIADH involves the excessive release of ADH, leading to water retention and dilutional
hyponatremia. The serum sodium level drops below the normal range because the excess
water expands the extracellular fluid volume. This condition results in a low serum
osmolality, which is characteristic of the disorder.
3. In chronic kidney disease (CKD), the nurse monitors for secondary hyperparathyroidism.
What is the underlying cause of this complication?
A. Excessive excretion of calcium by the kidneys
B. Hypocalcemia due to decreased Vitamin D activation and hyperphosphatemia
C. Hypercalcemia resulting from bone resorption
D. Hypophosphatemia causing parathyroid inhibition
Correct Answer: B
As kidney function declines, the kidneys lose the ability to activate Vitamin D and excrete
phosphate. Low levels of active Vitamin D lead to decreased calcium absorption, while high
phosphate levels bind with calcium. The resulting hypocalcemia stimulates the parathyroid
glands to release PTH in an attempt to normalize serum calcium.
4. Which clinical manifestation is a hallmark of Nephrotic Syndrome?
A. Gross hematuria and hypertension
, B. Kussmaul respirations and metabolic acidosis
C. Oliguria with high urine specific gravity
D. Proteinuria exceeding 3.5 grams per day
Correct Answer: D
Nephrotic syndrome is characterized by massive proteinuria due to increased glomerular
permeability. This loss of protein leads to hypoalbuminemia and subsequent generalized
edema (anasarca). It is distinct from nephritic syndrome, which is more commonly
associated with hematuria and inflammation.
5. A patient presents with central obesity, a ‘buffalo hump,’ and purple striae on the
abdomen. Which hormonal imbalance does the nurse suspect?
A. Excess of cortisol
B. Deficiency of aldosterone
C. Excess of growth hormone
D. Deficiency of thyroid-stimulating hormone
Correct Answer: A
These symptoms are classic indicators of Cushing’s syndrome, which results from
prolonged exposure to excess glucocorticoids like cortisol. Cortisol causes a redistribution
of fat to the trunk and face while thinning the skin, leading to striae. Chronic
hypercortisolism also causes muscle wasting in the extremities and glucose intolerance.
Pathophysiology | Actual Q&A with
Rationale (NUR376 Exam 4) | Concordia
1. A patient is diagnosed with Acute Kidney Injury (AKI) in the prerenal stage. Which of the
following pathophysiological mechanisms is primarily responsible for this condition?
A. Direct damage to the renal parenchyma
B. Obstruction of the urinary tract outflow
C. Nephrotoxic injury to the basement membrane
D. Reduced renal blood flow leading to decreased glomerular perfusion
Correct Answer: D
Prerenal AKI is caused by factors that reduce systemic circulation, causing a decrease in
renal blood flow. This leads to a reduction in glomerular filtration rate as the kidneys are
not being adequately perfused. Common causes include dehydration, heart failure, or
decreased cardiac output.
2. A client is admitted with Syndrome of Inappropriate Antidiuretic Hormone (SIADH). Which
serum laboratory value is the nurse most likely to find?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Serum potassium 5.8 mEq/L
,D. Serum calcium 11.5 mg/dL
Correct Answer: B
SIADH involves the excessive release of ADH, leading to water retention and dilutional
hyponatremia. The serum sodium level drops below the normal range because the excess
water expands the extracellular fluid volume. This condition results in a low serum
osmolality, which is characteristic of the disorder.
3. In chronic kidney disease (CKD), the nurse monitors for secondary hyperparathyroidism.
What is the underlying cause of this complication?
A. Excessive excretion of calcium by the kidneys
B. Hypocalcemia due to decreased Vitamin D activation and hyperphosphatemia
C. Hypercalcemia resulting from bone resorption
D. Hypophosphatemia causing parathyroid inhibition
Correct Answer: B
As kidney function declines, the kidneys lose the ability to activate Vitamin D and excrete
phosphate. Low levels of active Vitamin D lead to decreased calcium absorption, while high
phosphate levels bind with calcium. The resulting hypocalcemia stimulates the parathyroid
glands to release PTH in an attempt to normalize serum calcium.
4. Which clinical manifestation is a hallmark of Nephrotic Syndrome?
A. Gross hematuria and hypertension
, B. Kussmaul respirations and metabolic acidosis
C. Oliguria with high urine specific gravity
D. Proteinuria exceeding 3.5 grams per day
Correct Answer: D
Nephrotic syndrome is characterized by massive proteinuria due to increased glomerular
permeability. This loss of protein leads to hypoalbuminemia and subsequent generalized
edema (anasarca). It is distinct from nephritic syndrome, which is more commonly
associated with hematuria and inflammation.
5. A patient presents with central obesity, a ‘buffalo hump,’ and purple striae on the
abdomen. Which hormonal imbalance does the nurse suspect?
A. Excess of cortisol
B. Deficiency of aldosterone
C. Excess of growth hormone
D. Deficiency of thyroid-stimulating hormone
Correct Answer: A
These symptoms are classic indicators of Cushing’s syndrome, which results from
prolonged exposure to excess glucocorticoids like cortisol. Cortisol causes a redistribution
of fat to the trunk and face while thinning the skin, leading to striae. Chronic
hypercortisolism also causes muscle wasting in the extremities and glucose intolerance.
