NR283 Pathophysiology Quiz 3 (Latest-2021)/ NR 283
Pathophysiology Quiz 3/ NR283 Quiz 3 / NR 283 Quiz
3: Chamberlain College of Nursing |100% Correct
Answers, Download to Score “A”|
Section I: Renal & Urinary Pathophysiology (Questions 1–35)
1. A patient with chronic kidney disease (CKD) develops normocytic,
normochromic anemia. The nurse understands the primary mechanism is:
A. Iron deficiency from poor dietary intake
B. Decreased erythropoietin production by the kidneys
C. Vitamin B12 malabsorption in the gut
D. Increased hemolysis of red blood cells
B. Decreased erythropoietin production by the kidneys
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production in the bone marrow. In CKD, functional renal tissue is lost,
leading to decreased EPO synthesis and subsequent anemia. Iron and B12
deficiencies may coexist but are not the primary CKD-related mechanism.
Hemolysis is not characteristic of CKD anemia .
2. A patient presents with hematuria, proteinuria, hypertension, and
periorbital edema two weeks after a streptococcal throat infection. The
pathophysiology involves:
A. Ischemic acute tubular necrosis
B. Immune complex deposition in the glomeruli
C. Ureteral obstruction by calculi
D. Prerenal azotemia from dehydration
B. Immune complex deposition in the glomeruli
Rationale: Acute post-streptococcal glomerulonephritis is a type III
hypersensitivity reaction. Immune complexes (antigen-antibody) deposit in the
,glomerular basement membrane, activating complement and causing
inflammation. This damages the filtration barrier, leading to hematuria,
proteinuria, and decreased GFR with resultant hypertension and edema .
3. In a patient with CKD, metabolic acidosis develops primarily because of:
A. Increased excretion of hydrogen ions
B. Decreased excretion of H⁺ and decreased bicarbonate regeneration
C. Hyperventilation causing CO₂ retention
D. Excessive bicarbonate ingestion
B. Decreased excretion of H⁺ and decreased bicarbonate regeneration
Rationale: The kidneys normally excrete hydrogen ions and regenerate
bicarbonate. In CKD, nephron loss impairs both functions, leading to
accumulation of H⁺ and depletion of HCO₃⁻. The result is a high anion gap
metabolic acidosis. Respiratory compensation (Kussmaul breathing) occurs but
does not correct the underlying renal defect .
4. Nephrotic syndrome is characterized by massive proteinuria. The
underlying glomerular change is:
A. Decreased permeability of the glomerular basement membrane
B. Increased permeability allowing proteins to escape into urine
C. Enhanced tubular reabsorption of albumin
D. Reduced glomerular filtration rate
B. Increased permeability allowing proteins to escape into urine
Rationale: Nephrotic syndrome results from increased permeability of the
glomerular filtration barrier, permitting large proteins (especially albumin) to pass
into the urine. The resulting hypoalbuminemia decreases plasma oncotic pressure,
causing edema. Decreased GFR would cause azotemia, not proteinuria .
,5. A patient with acute kidney injury (AKI) following sepsis has urine output
of 200 mL/day. The nurse identifies this as which phase of AKI?
A. Diuretic phase
B. Oliguric phase
C. Recovery phase
D. Prerenal phase
B. Oliguric phase
Rationale: The oliguric phase of AKI is characterized by urine output less
than 400 mL/day. It typically lasts 1–3 weeks and is associated with fluid retention,
electrolyte imbalances (especially hyperkalemia), and accumulation of nitrogenous
wastes. The diuretic phase follows with polyuria as tubular function recovers .
6. A patient with a lower urinary tract obstruction is at highest risk for which
complication?
A. Glomerulonephritis
B. Vesicoureteral reflux and pyelonephritis
C. Nephrotic syndrome
D. Renal artery stenosis
B. Vesicoureteral reflux and pyelonephritis
Rationale: Lower urinary tract obstruction (e.g., from BPH or urethral
stricture) increases bladder pressure. This can cause urine to reflux into the ureters
(vesicoureteral reflux), carrying bacteria upward to the kidneys and leading to
pyelonephritis. While calculi may form due to stasis, infection risk is the most
immediate concern .
7. The most common composition of renal calculi is:
A. Magnesium ammonium phosphate (struvite)
B. Calcium oxalate or calcium phosphate
, C. Uric acid
D. Cystine
B. Calcium oxalate or calcium phosphate
Rationale: Approximately 70–80% of kidney stones are calcium-based,
primarily calcium oxalate. Struvite stones are associated with urease-producing
bacteria (e.g., Proteus). Uric acid stones are radiolucent and associated with gout.
Cystine stones are rare and genetic .
8. The most important factor in the formation of renal calculi is:
A. Body temperature
B. Urine pH
C. Gender
D. Serum calcium levels
B. Urine pH
Rationale: Urine pH influences the solubility of stone-forming substances.
Uric acid stones form in acidic urine; struvite stones form in alkaline urine. While
supersaturation of minerals is necessary, urine pH is the single most modifiable
factor affecting crystallization .
9. A 75-year-old male reports loss of urine when coughing or sneezing. The
nurse identifies this as:
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
B. Stress incontinence
Rationale: Stress incontinence occurs when increased intra-abdominal
pressure (from coughing, sneezing, laughing, or lifting) overcomes urethral
Pathophysiology Quiz 3/ NR283 Quiz 3 / NR 283 Quiz
3: Chamberlain College of Nursing |100% Correct
Answers, Download to Score “A”|
Section I: Renal & Urinary Pathophysiology (Questions 1–35)
1. A patient with chronic kidney disease (CKD) develops normocytic,
normochromic anemia. The nurse understands the primary mechanism is:
A. Iron deficiency from poor dietary intake
B. Decreased erythropoietin production by the kidneys
C. Vitamin B12 malabsorption in the gut
D. Increased hemolysis of red blood cells
B. Decreased erythropoietin production by the kidneys
Rationale: The kidneys produce erythropoietin (EPO), which stimulates red
blood cell production in the bone marrow. In CKD, functional renal tissue is lost,
leading to decreased EPO synthesis and subsequent anemia. Iron and B12
deficiencies may coexist but are not the primary CKD-related mechanism.
Hemolysis is not characteristic of CKD anemia .
2. A patient presents with hematuria, proteinuria, hypertension, and
periorbital edema two weeks after a streptococcal throat infection. The
pathophysiology involves:
A. Ischemic acute tubular necrosis
B. Immune complex deposition in the glomeruli
C. Ureteral obstruction by calculi
D. Prerenal azotemia from dehydration
B. Immune complex deposition in the glomeruli
Rationale: Acute post-streptococcal glomerulonephritis is a type III
hypersensitivity reaction. Immune complexes (antigen-antibody) deposit in the
,glomerular basement membrane, activating complement and causing
inflammation. This damages the filtration barrier, leading to hematuria,
proteinuria, and decreased GFR with resultant hypertension and edema .
3. In a patient with CKD, metabolic acidosis develops primarily because of:
A. Increased excretion of hydrogen ions
B. Decreased excretion of H⁺ and decreased bicarbonate regeneration
C. Hyperventilation causing CO₂ retention
D. Excessive bicarbonate ingestion
B. Decreased excretion of H⁺ and decreased bicarbonate regeneration
Rationale: The kidneys normally excrete hydrogen ions and regenerate
bicarbonate. In CKD, nephron loss impairs both functions, leading to
accumulation of H⁺ and depletion of HCO₃⁻. The result is a high anion gap
metabolic acidosis. Respiratory compensation (Kussmaul breathing) occurs but
does not correct the underlying renal defect .
4. Nephrotic syndrome is characterized by massive proteinuria. The
underlying glomerular change is:
A. Decreased permeability of the glomerular basement membrane
B. Increased permeability allowing proteins to escape into urine
C. Enhanced tubular reabsorption of albumin
D. Reduced glomerular filtration rate
B. Increased permeability allowing proteins to escape into urine
Rationale: Nephrotic syndrome results from increased permeability of the
glomerular filtration barrier, permitting large proteins (especially albumin) to pass
into the urine. The resulting hypoalbuminemia decreases plasma oncotic pressure,
causing edema. Decreased GFR would cause azotemia, not proteinuria .
,5. A patient with acute kidney injury (AKI) following sepsis has urine output
of 200 mL/day. The nurse identifies this as which phase of AKI?
A. Diuretic phase
B. Oliguric phase
C. Recovery phase
D. Prerenal phase
B. Oliguric phase
Rationale: The oliguric phase of AKI is characterized by urine output less
than 400 mL/day. It typically lasts 1–3 weeks and is associated with fluid retention,
electrolyte imbalances (especially hyperkalemia), and accumulation of nitrogenous
wastes. The diuretic phase follows with polyuria as tubular function recovers .
6. A patient with a lower urinary tract obstruction is at highest risk for which
complication?
A. Glomerulonephritis
B. Vesicoureteral reflux and pyelonephritis
C. Nephrotic syndrome
D. Renal artery stenosis
B. Vesicoureteral reflux and pyelonephritis
Rationale: Lower urinary tract obstruction (e.g., from BPH or urethral
stricture) increases bladder pressure. This can cause urine to reflux into the ureters
(vesicoureteral reflux), carrying bacteria upward to the kidneys and leading to
pyelonephritis. While calculi may form due to stasis, infection risk is the most
immediate concern .
7. The most common composition of renal calculi is:
A. Magnesium ammonium phosphate (struvite)
B. Calcium oxalate or calcium phosphate
, C. Uric acid
D. Cystine
B. Calcium oxalate or calcium phosphate
Rationale: Approximately 70–80% of kidney stones are calcium-based,
primarily calcium oxalate. Struvite stones are associated with urease-producing
bacteria (e.g., Proteus). Uric acid stones are radiolucent and associated with gout.
Cystine stones are rare and genetic .
8. The most important factor in the formation of renal calculi is:
A. Body temperature
B. Urine pH
C. Gender
D. Serum calcium levels
B. Urine pH
Rationale: Urine pH influences the solubility of stone-forming substances.
Uric acid stones form in acidic urine; struvite stones form in alkaline urine. While
supersaturation of minerals is necessary, urine pH is the single most modifiable
factor affecting crystallization .
9. A 75-year-old male reports loss of urine when coughing or sneezing. The
nurse identifies this as:
A. Urge incontinence
B. Stress incontinence
C. Overflow incontinence
D. Functional incontinence
B. Stress incontinence
Rationale: Stress incontinence occurs when increased intra-abdominal
pressure (from coughing, sneezing, laughing, or lifting) overcomes urethral
