NSG 530
EXAM 3
Advanced Pathophysiology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included
➢Exam 3 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 3 ............................................................ 2
NSG 530 Exam 3 Study Guide................................55
NSG 530 Exam 3
CASE: A 28-year-old woman presents with fever, flank pain, and dysuria.
Urinalysis reveals pyuria and bacteriuria. CT scan shows inflammation extending
from the renal pelvis into the renal parenchyma.
1. This patient most likely has:
A. Cystitis
B. Pyelonephritis
C. Nephrotic syndrome
D. Renal cell carcinoma
Correct Answer: B
Rationale: Pyelonephritis is inflammation of the renal pelvis and the kidney. It typically
presents with fever, flank pain, and dysuria, distinguishing it from cystitis (bladder
inflammation) which causes frequency, urgency, and dysuria without fever or flank pain.
CT findings of inflammation extending into renal parenchyma confirm the diagnosis.
,CASE: A 45-year-old patient with recurrent urinary tract infections presents with
hypertension, progressive renal dysfunction, and small scarred kidneys on
imaging. History reveals multiple episodes of acute pyelonephritis and
vesicoureteral reflux.
2. This patient most likely has:
A. Acute glomerulonephritis
B. Chronic pyelonephritis
C. Renal adenoma
D. Nephrotic syndrome
Correct Answer: B
Rationale: Chronic pyelonephritis is characterized by interstitial fibrosis and atrophy of
tubules due to multiple bouts of acute pyelonephritis. It can be associated with chronic
UTIs, vesicoureteral reflux, or kidney stones. The progressive renal dysfunction,
hypertension, and scarred kidneys are classic findings of chronic tubulointerstitial
disease.
CASE: A 24-year-old woman presents with frequency, urgency, dysuria, and lower
back pain. Urine culture grows Escherichia coli.
3. This patient most likely has:
A. Pyelonephritis
B. Cystitis
C. Glomerulonephritis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Cystitis is inflammation of the bladder. Common pathogens are E. coli and
Staphylococcus saprophyticus. Symptoms include frequency, urgency, dysuria, and
lower back pain. Unlike pyelonephritis, cystitis does not cause fever or flank pain. E. coli
is the most common cause of uncomplicated urinary tract infections.
4. A patient with cystitis asks why E. coli is the most common cause. The nurse's
BEST explanation is:
, A. E. coli is resistant to all antibiotics
B. E. coli has adhesins that allow it to attach to uroepithelial cells and ascend the
urinary tract
C. E. coli only infects the kidneys
D. E. coli is transmitted only through sexual contact
Correct Answer: B
Rationale: E. coli is the most common cause of cystitis because uropathogenic strains
express adhesins (P fimbriae, type 1 pili) that allow attachment to uroepithelial cells in
the bladder. This attachment prevents clearance by urine flow and allows bacterial
ascent into the urinary tract. Most E. coli UTIs are susceptible to common antibiotics.
CASE: A 55-year-old man presents with painless gross hematuria, flank mass, and
weight loss. CT scan reveals a solid renal mass arising from the kidney tubules.
5. This patient most likely has:
A. Renal adenoma
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Nephrotic syndrome
Correct Answer: B
Rationale: Renal cell carcinoma is a cancerous tumor that arises from kidney tubule
cells. It classically presents with the triad of hematuria, flank pain, and palpable mass,
though this triad is seen in only 10% of cases. Painless gross hematuria is the most
common presenting symptom. Risk factors include smoking, obesity, and hypertension.
6. A patient with renal cell carcinoma has a small, slow-growing glandular
noncancerous tumor found incidentally on imaging. This describes:
A. Renal cell carcinoma
B. Renal adenoma
C. Transitional cell carcinoma
D. Wilms tumor
,Correct Answer: B
Rationale: Renal adenoma is a small, slow-growing glandular noncancerous tumor of
the kidney. It is often found incidentally on imaging performed for other reasons. Unlike
renal cell carcinoma, it does not metastasize and is usually asymptomatic. Transitional
cell carcinoma arises from the urothelium, not tubule cells.
CASE: A 68-year-old man presents with gross painless hematuria. Cystoscopy
reveals a papillary tumor in the urinary bladder. The patient has a 40 pack-year
smoking history.
7. This patient most likely has:
A. Renal cell carcinoma
B. Transitional cell carcinoma
C. Renal adenoma
D. Prostate cancer
Correct Answer: B
Rationale: Transitional cell carcinoma (urothelial carcinoma) is a malignant tumor of the
urinary tract often found within the urinary bladder or renal pelvis. It generally occurs in
older men and presents with gross painless hematuria. Smoking is the most significant
risk factor, causing aromatic amines to be excreted in urine, damaging urothelial cells.
8. A patient with transitional cell carcinoma of the renal pelvis asks about the
origin of this tumor. The nurse correctly explains that:
A. It arises from kidney tubule cells
B. It arises from the urothelium (transitional epithelium) lining the urinary tract
C. It arises from the adrenal cortex
D. It arises from the renal capsule
Correct Answer: B
Rationale: Transitional cell carcinoma arises from the urothelium (transitional
epithelium) that lines the urinary tract from the renal pelvis to the urethra. This explains
why tumors can occur in the renal pelvis, ureter, bladder, and urethra. Renal cell
carcinoma arises from kidney tubule cells; adrenal tumors arise from the adrenal cortex.
,CASE: A 10-year-old child presents 2 weeks after a streptococcal throat infection
with hematuria, proteinuria, oliguria, hypertension, and peripheral edema.
Urinalysis shows red blood cell casts.
9. This child most likely has:
A. Nephrotic syndrome
B. Primary glomerulonephritis
C. Cystitis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Primary glomerulonephritis is inflammation of the glomeruli of the kidneys
that occurs independently of other chronic conditions, usually the result of an acute
infectious process (post-streptococcal). Symptoms include hematuria with red blood cell
casts, proteinuria with albumin, oliguria, hypertension, edema, and nephrotic sediment.
RBC casts are pathognomonic for glomerular disease.
CASE: A 35-year-old woman with systemic lupus erythematosus presents with
hematuria, proteinuria, and declining renal function. Renal biopsy shows immune
complex deposition in the glomeruli.
10. This patient has:
A. Primary glomerulonephritis
B. Secondary glomerulonephritis
C. Cystitis
D. Renal adenoma
Correct Answer: B
Rationale: Secondary glomerulonephritis is inflammation of the glomeruli that results
from other chronic conditions, such as lupus erythematosus or diabetes. Primary
glomerulonephritis occurs independently of other conditions, usually from an acute
infectious process. In lupus nephritis, immune complexes deposit in glomeruli, causing
inflammation and damage.
,11. A patient with glomerulonephritis has red blood cell casts in the urine. The
nurse understands that RBC casts indicate:
A. Lower urinary tract bleeding
B. Glomerular inflammation allowing RBCs to leak into tubules where they become
embedded in protein matrix
C. Bladder infection
D. Kidney stones
Correct Answer: B
Rationale: Red blood cell casts form when RBCs leak through damaged glomeruli into
the renal tubules, where they become embedded in a protein matrix (Tamm-Horsfall
protein) that molds to the tubular shape. RBC casts are pathognomonic for glomerular
disease and distinguish upper from lower urinary tract bleeding.
CASE: A 40-year-old patient presents with massive proteinuria (>3.5 g/day),
hypoalbuminemia, hyperlipidemia, and severe peripheral edema. Renal biopsy
shows membranous nephropathy.
12. This patient has:
A. Acute pyelonephritis
B. Nephrotic syndrome
C. Cystitis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Nephrotic syndrome is characterized by loss of large amounts of plasma
protein, usually albumin, through urine due to increased permeability of the glomerular
membrane. The classic tetrad includes massive proteinuria (>3.5 g/day),
hypoalbuminemia, hyperlipidemia, and edema. Membranous glomerulonephritis is a
common cause.
13. A patient with nephrotic syndrome has severe peripheral edema. The nurse
understands that this edema results from:
A. Excessive sodium intake
, B. Decreased plasma oncotic pressure from hypoalbuminemia, causing fluid to shift
into interstitial spaces
C. Right-sided heart failure
D. Lymphatic obstruction
Correct Answer: B
Rationale: In nephrotic syndrome, massive proteinuria causes hypoalbuminemia.
Albumin is the primary protein maintaining plasma oncotic pressure. When albumin is
lost, plasma oncotic pressure decreases, causing fluid to shift from intravascular to
interstitial spaces (edema). The kidneys also retain sodium and water, worsening
edema.
14. A patient with nephrotic syndrome asks about potential causes. The nurse
correctly identifies which of the following as causes of nephrotic syndrome?
(Select all that apply)
A. Membranous glomerulonephritis
B. Minimal change nephropathy
C. Focal segmental glomerulosclerosis
D. Systemic lupus erythematosus
E. Acute cystitis
Correct Answer: A, B, C, D
Rationale: Causes of nephrotic syndrome include membranous glomerulonephritis,
minimal change nephropathy (most common in children), focal segmental
glomerulosclerosis, and systemic diseases such as diabetes or lupus. Acute cystitis is a
bladder infection and does not cause nephrotic syndrome.
CASE: A 25-year-old woman presents with hemoptysis and rapidly declining renal
function. Renal biopsy shows linear IgG deposition along the glomerular
basement membrane. Anti-GBM antibodies are positive.
15. This patient has:
A. Membranous nephropathy
B. Anti-glomerular basement membrane disease (Goodpasture syndrome)
, C. Minimal change disease
D. Diabetic nephropathy
Correct Answer: B
Rationale: Anti-glomerular basement membrane disease (Goodpasture syndrome) is
characterized by autoantibodies against type IV collagen in the glomerular basement
membrane and alveolar basement membrane. It presents with rapidly progressive
glomerulonephritis and pulmonary hemorrhage (hemoptysis). Linear IgG deposition on
immunofluorescence is diagnostic.
CASE: A newborn boy is noted to have the urethral opening on the undersurface
(ventral aspect) of the penis, rather than at the tip.
16. This congenital abnormality is called:
A. Epispadias
B. Hypospadias
C. Phimosis
D. Paraphimosis
Correct Answer: B
Rationale: Hypospadias is a congenital abnormality in which the male urethral opening
is on the undersurface of the penis, instead of at its tip. It is one of the most common
congenital anomalies of the male genitalia. Epispadias is opening on the dorsal (upper)
surface. Phimosis and paraphimosis involve the foreskin.
17. A patient with hypospadias has the urethral meatus located on the ventral
surface of the penis. The nurse understands that surgical correction is
recommended because:
A. The condition always causes urinary incontinence
B. It can cause difficulty with urination, infertility, and psychological distress if
uncorrected
C. It is associated with testicular cancer
D. It causes recurrent urinary tract infections in all cases
Correct Answer: B
EXAM 3
Advanced Pathophysiology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included
➢Exam 3 Comprehensive Study Guide
,Table of Contents
NSG 530 Exam 3 ............................................................ 2
NSG 530 Exam 3 Study Guide................................55
NSG 530 Exam 3
CASE: A 28-year-old woman presents with fever, flank pain, and dysuria.
Urinalysis reveals pyuria and bacteriuria. CT scan shows inflammation extending
from the renal pelvis into the renal parenchyma.
1. This patient most likely has:
A. Cystitis
B. Pyelonephritis
C. Nephrotic syndrome
D. Renal cell carcinoma
Correct Answer: B
Rationale: Pyelonephritis is inflammation of the renal pelvis and the kidney. It typically
presents with fever, flank pain, and dysuria, distinguishing it from cystitis (bladder
inflammation) which causes frequency, urgency, and dysuria without fever or flank pain.
CT findings of inflammation extending into renal parenchyma confirm the diagnosis.
,CASE: A 45-year-old patient with recurrent urinary tract infections presents with
hypertension, progressive renal dysfunction, and small scarred kidneys on
imaging. History reveals multiple episodes of acute pyelonephritis and
vesicoureteral reflux.
2. This patient most likely has:
A. Acute glomerulonephritis
B. Chronic pyelonephritis
C. Renal adenoma
D. Nephrotic syndrome
Correct Answer: B
Rationale: Chronic pyelonephritis is characterized by interstitial fibrosis and atrophy of
tubules due to multiple bouts of acute pyelonephritis. It can be associated with chronic
UTIs, vesicoureteral reflux, or kidney stones. The progressive renal dysfunction,
hypertension, and scarred kidneys are classic findings of chronic tubulointerstitial
disease.
CASE: A 24-year-old woman presents with frequency, urgency, dysuria, and lower
back pain. Urine culture grows Escherichia coli.
3. This patient most likely has:
A. Pyelonephritis
B. Cystitis
C. Glomerulonephritis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Cystitis is inflammation of the bladder. Common pathogens are E. coli and
Staphylococcus saprophyticus. Symptoms include frequency, urgency, dysuria, and
lower back pain. Unlike pyelonephritis, cystitis does not cause fever or flank pain. E. coli
is the most common cause of uncomplicated urinary tract infections.
4. A patient with cystitis asks why E. coli is the most common cause. The nurse's
BEST explanation is:
, A. E. coli is resistant to all antibiotics
B. E. coli has adhesins that allow it to attach to uroepithelial cells and ascend the
urinary tract
C. E. coli only infects the kidneys
D. E. coli is transmitted only through sexual contact
Correct Answer: B
Rationale: E. coli is the most common cause of cystitis because uropathogenic strains
express adhesins (P fimbriae, type 1 pili) that allow attachment to uroepithelial cells in
the bladder. This attachment prevents clearance by urine flow and allows bacterial
ascent into the urinary tract. Most E. coli UTIs are susceptible to common antibiotics.
CASE: A 55-year-old man presents with painless gross hematuria, flank mass, and
weight loss. CT scan reveals a solid renal mass arising from the kidney tubules.
5. This patient most likely has:
A. Renal adenoma
B. Renal cell carcinoma
C. Transitional cell carcinoma
D. Nephrotic syndrome
Correct Answer: B
Rationale: Renal cell carcinoma is a cancerous tumor that arises from kidney tubule
cells. It classically presents with the triad of hematuria, flank pain, and palpable mass,
though this triad is seen in only 10% of cases. Painless gross hematuria is the most
common presenting symptom. Risk factors include smoking, obesity, and hypertension.
6. A patient with renal cell carcinoma has a small, slow-growing glandular
noncancerous tumor found incidentally on imaging. This describes:
A. Renal cell carcinoma
B. Renal adenoma
C. Transitional cell carcinoma
D. Wilms tumor
,Correct Answer: B
Rationale: Renal adenoma is a small, slow-growing glandular noncancerous tumor of
the kidney. It is often found incidentally on imaging performed for other reasons. Unlike
renal cell carcinoma, it does not metastasize and is usually asymptomatic. Transitional
cell carcinoma arises from the urothelium, not tubule cells.
CASE: A 68-year-old man presents with gross painless hematuria. Cystoscopy
reveals a papillary tumor in the urinary bladder. The patient has a 40 pack-year
smoking history.
7. This patient most likely has:
A. Renal cell carcinoma
B. Transitional cell carcinoma
C. Renal adenoma
D. Prostate cancer
Correct Answer: B
Rationale: Transitional cell carcinoma (urothelial carcinoma) is a malignant tumor of the
urinary tract often found within the urinary bladder or renal pelvis. It generally occurs in
older men and presents with gross painless hematuria. Smoking is the most significant
risk factor, causing aromatic amines to be excreted in urine, damaging urothelial cells.
8. A patient with transitional cell carcinoma of the renal pelvis asks about the
origin of this tumor. The nurse correctly explains that:
A. It arises from kidney tubule cells
B. It arises from the urothelium (transitional epithelium) lining the urinary tract
C. It arises from the adrenal cortex
D. It arises from the renal capsule
Correct Answer: B
Rationale: Transitional cell carcinoma arises from the urothelium (transitional
epithelium) that lines the urinary tract from the renal pelvis to the urethra. This explains
why tumors can occur in the renal pelvis, ureter, bladder, and urethra. Renal cell
carcinoma arises from kidney tubule cells; adrenal tumors arise from the adrenal cortex.
,CASE: A 10-year-old child presents 2 weeks after a streptococcal throat infection
with hematuria, proteinuria, oliguria, hypertension, and peripheral edema.
Urinalysis shows red blood cell casts.
9. This child most likely has:
A. Nephrotic syndrome
B. Primary glomerulonephritis
C. Cystitis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Primary glomerulonephritis is inflammation of the glomeruli of the kidneys
that occurs independently of other chronic conditions, usually the result of an acute
infectious process (post-streptococcal). Symptoms include hematuria with red blood cell
casts, proteinuria with albumin, oliguria, hypertension, edema, and nephrotic sediment.
RBC casts are pathognomonic for glomerular disease.
CASE: A 35-year-old woman with systemic lupus erythematosus presents with
hematuria, proteinuria, and declining renal function. Renal biopsy shows immune
complex deposition in the glomeruli.
10. This patient has:
A. Primary glomerulonephritis
B. Secondary glomerulonephritis
C. Cystitis
D. Renal adenoma
Correct Answer: B
Rationale: Secondary glomerulonephritis is inflammation of the glomeruli that results
from other chronic conditions, such as lupus erythematosus or diabetes. Primary
glomerulonephritis occurs independently of other conditions, usually from an acute
infectious process. In lupus nephritis, immune complexes deposit in glomeruli, causing
inflammation and damage.
,11. A patient with glomerulonephritis has red blood cell casts in the urine. The
nurse understands that RBC casts indicate:
A. Lower urinary tract bleeding
B. Glomerular inflammation allowing RBCs to leak into tubules where they become
embedded in protein matrix
C. Bladder infection
D. Kidney stones
Correct Answer: B
Rationale: Red blood cell casts form when RBCs leak through damaged glomeruli into
the renal tubules, where they become embedded in a protein matrix (Tamm-Horsfall
protein) that molds to the tubular shape. RBC casts are pathognomonic for glomerular
disease and distinguish upper from lower urinary tract bleeding.
CASE: A 40-year-old patient presents with massive proteinuria (>3.5 g/day),
hypoalbuminemia, hyperlipidemia, and severe peripheral edema. Renal biopsy
shows membranous nephropathy.
12. This patient has:
A. Acute pyelonephritis
B. Nephrotic syndrome
C. Cystitis
D. Renal cell carcinoma
Correct Answer: B
Rationale: Nephrotic syndrome is characterized by loss of large amounts of plasma
protein, usually albumin, through urine due to increased permeability of the glomerular
membrane. The classic tetrad includes massive proteinuria (>3.5 g/day),
hypoalbuminemia, hyperlipidemia, and edema. Membranous glomerulonephritis is a
common cause.
13. A patient with nephrotic syndrome has severe peripheral edema. The nurse
understands that this edema results from:
A. Excessive sodium intake
, B. Decreased plasma oncotic pressure from hypoalbuminemia, causing fluid to shift
into interstitial spaces
C. Right-sided heart failure
D. Lymphatic obstruction
Correct Answer: B
Rationale: In nephrotic syndrome, massive proteinuria causes hypoalbuminemia.
Albumin is the primary protein maintaining plasma oncotic pressure. When albumin is
lost, plasma oncotic pressure decreases, causing fluid to shift from intravascular to
interstitial spaces (edema). The kidneys also retain sodium and water, worsening
edema.
14. A patient with nephrotic syndrome asks about potential causes. The nurse
correctly identifies which of the following as causes of nephrotic syndrome?
(Select all that apply)
A. Membranous glomerulonephritis
B. Minimal change nephropathy
C. Focal segmental glomerulosclerosis
D. Systemic lupus erythematosus
E. Acute cystitis
Correct Answer: A, B, C, D
Rationale: Causes of nephrotic syndrome include membranous glomerulonephritis,
minimal change nephropathy (most common in children), focal segmental
glomerulosclerosis, and systemic diseases such as diabetes or lupus. Acute cystitis is a
bladder infection and does not cause nephrotic syndrome.
CASE: A 25-year-old woman presents with hemoptysis and rapidly declining renal
function. Renal biopsy shows linear IgG deposition along the glomerular
basement membrane. Anti-GBM antibodies are positive.
15. This patient has:
A. Membranous nephropathy
B. Anti-glomerular basement membrane disease (Goodpasture syndrome)
, C. Minimal change disease
D. Diabetic nephropathy
Correct Answer: B
Rationale: Anti-glomerular basement membrane disease (Goodpasture syndrome) is
characterized by autoantibodies against type IV collagen in the glomerular basement
membrane and alveolar basement membrane. It presents with rapidly progressive
glomerulonephritis and pulmonary hemorrhage (hemoptysis). Linear IgG deposition on
immunofluorescence is diagnostic.
CASE: A newborn boy is noted to have the urethral opening on the undersurface
(ventral aspect) of the penis, rather than at the tip.
16. This congenital abnormality is called:
A. Epispadias
B. Hypospadias
C. Phimosis
D. Paraphimosis
Correct Answer: B
Rationale: Hypospadias is a congenital abnormality in which the male urethral opening
is on the undersurface of the penis, instead of at its tip. It is one of the most common
congenital anomalies of the male genitalia. Epispadias is opening on the dorsal (upper)
surface. Phimosis and paraphimosis involve the foreskin.
17. A patient with hypospadias has the urethral meatus located on the ventral
surface of the penis. The nurse understands that surgical correction is
recommended because:
A. The condition always causes urinary incontinence
B. It can cause difficulty with urination, infertility, and psychological distress if
uncorrected
C. It is associated with testicular cancer
D. It causes recurrent urinary tract infections in all cases
Correct Answer: B
