Pathophysiology Exam 3 Practice
Questions and Answers
The nurse working in an outpatient nephrology clinic knows that which of the
following are primary functions of the kidneys? (Select all that apply.)
A. Production of clotting factors
B. Homeostasis
C. Excretion of metabolic wastes
D. Regulation of acid-base balance
E. Metabolism of fats Correct answer- B, C, D
The kidneys do not metabolize fats.
Production of clotting factors is a primary function of the liver.
The kidneys maintain blood pressure using the RAAS and also produce
erythropoietin to stimulate RBC production.
In caring for a patient diagnosed with acute kidney injury, the nephrology
nurse knows that which of the following tests are specific for renal function?
(Select all that apply.)
A. Aspartate aminotransferase (AST)
B. Blood urea nitrogen
C. Creatinine
D. Glomerular filtration rate
E. White blood cell count Correct answer- B, C, D
AST related to LIVER function
In caring for a patient with acute kidney injury the nurse knows that the
patient's renal function has returned to normal range when the patient's GFR
measures:
A. 30-40 mL/min
B. 40-50 mL/min
C. 70-90 mL/min
D. 90-120 mL/min Correct answer- D
Normal GFR is 90-120 mL/min
Normal Creatinine 0.6-1.1 for females and 0.6-1.2 for males
Normal BUN is 10-20 mg/dL
*Be sure to know these normal values, you will use them daily as a nurse
,The nursing working in a geriatric living facility understands that as patients
age, which change in glomerular filtration rate is expected?
A. Increased GFR
B. Decreased GFR
C. Same GFR
D. No GFR Correct answer- B
Aging and renal function:
Decrease in renal blood flow and GFR → altered sodium and water balance
Number of nephrons decrease due to renal vascular and perfusion changes
Response to acid-base changes is delayed
Increased risk for drug toxicity
Alterations in thirst and water intake
Get dehydrated very easily; do not recognize thirst and heat
Decreased muscle mass may lead to decreased creatinine values
An older patient is experiencing urinary stasis. The registered nurse knows
that urinary stasis may lead to which of the following?
A. Increased GFR
B. Hypocoagulation
C. Hypertension
D. Infection Correct answer- D
Urinary stasis is a risk factor for developing UTI
Which of the following is classified as the most common primary mineral salt
composition of kidney stones?
A. Calcium
B. Struvite
C. Uric Acid
D. Cysteine Correct answer- A
A - calcium (i.e. oxalate or phosphate) is most common
*Note that a change in urine pH may lead to precipitation of stones
Which of the following are risk factors for developing renal tumors? (Select
all that apply.)
A. Female gender
B. Smoking
C. Obesity
D. Diabetes
E. Hypertension Correct answer- B, C, E
risk factors are male gender, smoking, obesity, uncontrolled hypertension
, The registered nurse would expect which of the following lab values for a
patient experiencing acute kidney failure?
A. Creatinine 3.5 mg/dL
B. Sodium 122 mEq/L
C. Albumin 3.5 g/dL
D. BUN 10 mg/dL Correct answer- A
the normal creatinine level is 0.6 - 1.2
This BUN is within normal range (BUN would be elevated in acute kidney
failure)
In caring for a patient experiencing acute kidney injury who has these lab
values: urinary output 15 mL/hr, BUN 30 mg/dL, and creatinine 3.5, the nurse
knows that the patient is experiencing which phase of acute kidney injury?
A. Initiation phase
B. Oliguric phase
C. Recovery (polyuric) phase
D. I don't remember the normal lab values Correct answer- B
Remember that there are phases of acute kidney injury -
Initiation phase is when the injury is just beginning and prevention is still
possible
Next is the oliguric phase where urinary output is decreased and nitrogenous
waste products are maintained (BUN and Creatinine)
There is also the recovery or polyuric/diuretic phase - diuresis is common
and BUN and creatinine decline
A 25-year-old female is diagnosed with urinary tract obstruction. While
planning care, the nurse realizes that the patient is expected to have
hydronephrosis and a decreased glomerular filtration rate caused by:
A. Decreased renal blood flow
B. Decreased peritubular capillary pressure
C. Dilation of renal pelvis and calyces proximal to blockage
D. Stimulation of antidiuretic hormone Correct answer- C
Hydroureter; dilation of ureter
Hydronephrosis: dilation/enlargement of renal pelvis and calyces
Ureterohydronephrosis: dilation of ureter AND renal pelvis and calyces
A 55-year-old male presents reporting urinary retention. Tests reveal that he
has a lower urinary tract obstruction. Which of the following is of most
concern to the nurse?
A. Vesicoureteral reflux and pyelonephritis
B. Formation of renal calculi
, C. Glomerulonephritis
D. Increased bladder compliance Correct answer- B
urine stasis occurs with urinary tract obstruction and can lead to the
formation of renal calculi and UTI
A 75-year-old male reports to his primary care provider loss of urine with
cough, sneezing, or laughing. Which of the following is the most likely
diagnosis the nurse will observe on the chart?
A. Urge incontinence
B. Overflow incontinence
C. Stress incontinence
D. Functional incontinence Correct answer- C
Reduced resistance is associated with the symptom of stress incontinence,
which is incontinence with coughing or sneezing.
A 29-year-old female presents with cloudy urine, flank pain, hematuria, and
fever. Which of the following does the nurse suspect the patient is most
likely experiencing?
A. Acute cystitis
B. Renal calculi
C. Chronic renal failure
D. Postrenal renal failure Correct answer- A
acute cystitis is infection/inflammation of bladder (UTI)
Although renal calculi can cause pain and hematuria, it is not manifested by
fever and cloudy urine.
A 30-year-old male is demonstrating hematuria with red blood cell casts and
proteinuria exceeding 3 to 5 g/day, with albumin being the major protein.
The most probable diagnosis the nurse will see documented on the chart is:
A. Cystitis
B. Chronic pyelonephritis
C. Acute glomerulonephritis
D. Renal calculi Correct answer- C
Two major symptoms distinctive of more severe glomerulonephritis are:
hematuria with red blood cell casts
(2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as
the major protein
A 54-year-old female is diagnosed with nephrotic syndrome. Which of the
following is a common symptom of this disease?
A. Hematuria
, B. Dysuria
C. Oliguria
D. Proteinuria Correct answer- D
Nephrotic syndrome is manifested by proteinuria
Nephrotic syndrome is diagnosed when the protein level in a 24-hour urine
collection is greater than 3.5 g
A 56-year-old male presents with flank pain and polyuria. Tests reveal that
he has an enlarged prostate. Which of the following types of renal failure
should the nurse monitor for as it is the most likely to occur?
A. Prerenal
B. Intrarenal
C. Extrarenal
D. Postrenal Correct answer- D
the patient will experience postrenal renal failure due to obstruction by the
prostate.
What if the test revealed acute tubular necrosis? intrarenal
While turning a patient with chronic renal failure, which principle should the
nurse recall? Bone fractures are a risk factor in chronic renal failure because:
A. Calcium is lost in the urine
B. Osteoblast activity is excessive
C. The kidneys fail to activate vitamin D
D. Autoantibodies to calcium molecules develop Correct answer- C
Hypocalcemia is accelerated by impaired renal synthesis of vitamin D
The combined effect of vitamin D deficiency can result in renal
osteodystrophies with increased risk for fractures.
A man was mildly confused, and his family brought him to adult day care
during the week. He was incontinent there every day until a nurse suggested
that they put a picture of a toilet on the bathroom door, and he became
continent. What incontinence is this? Correct answer- Functional
Incontinence
A woman has a bladder infection and is distressed to have episodes of
sudden strong need to urinate that cause her to become incontinent. What
incontinence is this? Correct answer- Urge Incontinence
A woman loses a small amount of urine involuntarily every time she sneezes.
What incontinence is this? Correct answer- Stress Incontinence
, A man with a caudal equine involvement in MS became incontinent when his
caregiver was late and was not available to assist with the morning
catheterization. What incontinence is this? Correct answer- Overflow
Incontinence
A 50-year-old male is experiencing reflux of chyme from the stomach. He is
diagnosed with gastroesophageal reflux. This condition is caused by:
A. Fibrosis of lower third of esophagus
B. Sympathetic nerve stimulation
C. Loss of muscle tone at the lower esophageal sphincter
D. Reverse peristalsis of the stomach Correct answer- C
GERD is due to a weak esophageal sphincter
A 22-year-old male underwent brain surgery to remove a tumor. Following
surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____
ulcer.
A. Infectious
B. Cushing
C. Ischemic
D. Curling Correct answer- B
Cushing ulcer is a stress ulcer associated with severe head trauma or brain
surgery.
Curling ulcers develop secondary to burns.
A 50-year-old male complains of frequently recurring abdominal pain,
diarrhea, and bloody stools. A possible diagnosis would be:
A. Ulcerative colitis
B. Hiatal hernia
C. Pyloric obstruction
D. Achalasia Correct answer- A
Ulcerative colitis is manifested by fever, elevated pulse rate, frequent
diarrhea (10 to 20 stools/day), urgency, obviously bloody stools, and
continuous lesions present in the colon.
Hiatal hernia is most often asymptomatic and would not be manifested by
abdominal pain.
Pyloric obstruction would be manifested by forceful or projectile vomiting.
Achalasia would be manifested by difficulty or uncomfortable swallowing.
A 16-year-old female presents with abdominal pain in the right lower
quadrant. Physical examination reveals rebound tenderness and a low-grade
fever. A possible diagnosis would be:
A. Colon cancer
Questions and Answers
The nurse working in an outpatient nephrology clinic knows that which of the
following are primary functions of the kidneys? (Select all that apply.)
A. Production of clotting factors
B. Homeostasis
C. Excretion of metabolic wastes
D. Regulation of acid-base balance
E. Metabolism of fats Correct answer- B, C, D
The kidneys do not metabolize fats.
Production of clotting factors is a primary function of the liver.
The kidneys maintain blood pressure using the RAAS and also produce
erythropoietin to stimulate RBC production.
In caring for a patient diagnosed with acute kidney injury, the nephrology
nurse knows that which of the following tests are specific for renal function?
(Select all that apply.)
A. Aspartate aminotransferase (AST)
B. Blood urea nitrogen
C. Creatinine
D. Glomerular filtration rate
E. White blood cell count Correct answer- B, C, D
AST related to LIVER function
In caring for a patient with acute kidney injury the nurse knows that the
patient's renal function has returned to normal range when the patient's GFR
measures:
A. 30-40 mL/min
B. 40-50 mL/min
C. 70-90 mL/min
D. 90-120 mL/min Correct answer- D
Normal GFR is 90-120 mL/min
Normal Creatinine 0.6-1.1 for females and 0.6-1.2 for males
Normal BUN is 10-20 mg/dL
*Be sure to know these normal values, you will use them daily as a nurse
,The nursing working in a geriatric living facility understands that as patients
age, which change in glomerular filtration rate is expected?
A. Increased GFR
B. Decreased GFR
C. Same GFR
D. No GFR Correct answer- B
Aging and renal function:
Decrease in renal blood flow and GFR → altered sodium and water balance
Number of nephrons decrease due to renal vascular and perfusion changes
Response to acid-base changes is delayed
Increased risk for drug toxicity
Alterations in thirst and water intake
Get dehydrated very easily; do not recognize thirst and heat
Decreased muscle mass may lead to decreased creatinine values
An older patient is experiencing urinary stasis. The registered nurse knows
that urinary stasis may lead to which of the following?
A. Increased GFR
B. Hypocoagulation
C. Hypertension
D. Infection Correct answer- D
Urinary stasis is a risk factor for developing UTI
Which of the following is classified as the most common primary mineral salt
composition of kidney stones?
A. Calcium
B. Struvite
C. Uric Acid
D. Cysteine Correct answer- A
A - calcium (i.e. oxalate or phosphate) is most common
*Note that a change in urine pH may lead to precipitation of stones
Which of the following are risk factors for developing renal tumors? (Select
all that apply.)
A. Female gender
B. Smoking
C. Obesity
D. Diabetes
E. Hypertension Correct answer- B, C, E
risk factors are male gender, smoking, obesity, uncontrolled hypertension
, The registered nurse would expect which of the following lab values for a
patient experiencing acute kidney failure?
A. Creatinine 3.5 mg/dL
B. Sodium 122 mEq/L
C. Albumin 3.5 g/dL
D. BUN 10 mg/dL Correct answer- A
the normal creatinine level is 0.6 - 1.2
This BUN is within normal range (BUN would be elevated in acute kidney
failure)
In caring for a patient experiencing acute kidney injury who has these lab
values: urinary output 15 mL/hr, BUN 30 mg/dL, and creatinine 3.5, the nurse
knows that the patient is experiencing which phase of acute kidney injury?
A. Initiation phase
B. Oliguric phase
C. Recovery (polyuric) phase
D. I don't remember the normal lab values Correct answer- B
Remember that there are phases of acute kidney injury -
Initiation phase is when the injury is just beginning and prevention is still
possible
Next is the oliguric phase where urinary output is decreased and nitrogenous
waste products are maintained (BUN and Creatinine)
There is also the recovery or polyuric/diuretic phase - diuresis is common
and BUN and creatinine decline
A 25-year-old female is diagnosed with urinary tract obstruction. While
planning care, the nurse realizes that the patient is expected to have
hydronephrosis and a decreased glomerular filtration rate caused by:
A. Decreased renal blood flow
B. Decreased peritubular capillary pressure
C. Dilation of renal pelvis and calyces proximal to blockage
D. Stimulation of antidiuretic hormone Correct answer- C
Hydroureter; dilation of ureter
Hydronephrosis: dilation/enlargement of renal pelvis and calyces
Ureterohydronephrosis: dilation of ureter AND renal pelvis and calyces
A 55-year-old male presents reporting urinary retention. Tests reveal that he
has a lower urinary tract obstruction. Which of the following is of most
concern to the nurse?
A. Vesicoureteral reflux and pyelonephritis
B. Formation of renal calculi
, C. Glomerulonephritis
D. Increased bladder compliance Correct answer- B
urine stasis occurs with urinary tract obstruction and can lead to the
formation of renal calculi and UTI
A 75-year-old male reports to his primary care provider loss of urine with
cough, sneezing, or laughing. Which of the following is the most likely
diagnosis the nurse will observe on the chart?
A. Urge incontinence
B. Overflow incontinence
C. Stress incontinence
D. Functional incontinence Correct answer- C
Reduced resistance is associated with the symptom of stress incontinence,
which is incontinence with coughing or sneezing.
A 29-year-old female presents with cloudy urine, flank pain, hematuria, and
fever. Which of the following does the nurse suspect the patient is most
likely experiencing?
A. Acute cystitis
B. Renal calculi
C. Chronic renal failure
D. Postrenal renal failure Correct answer- A
acute cystitis is infection/inflammation of bladder (UTI)
Although renal calculi can cause pain and hematuria, it is not manifested by
fever and cloudy urine.
A 30-year-old male is demonstrating hematuria with red blood cell casts and
proteinuria exceeding 3 to 5 g/day, with albumin being the major protein.
The most probable diagnosis the nurse will see documented on the chart is:
A. Cystitis
B. Chronic pyelonephritis
C. Acute glomerulonephritis
D. Renal calculi Correct answer- C
Two major symptoms distinctive of more severe glomerulonephritis are:
hematuria with red blood cell casts
(2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as
the major protein
A 54-year-old female is diagnosed with nephrotic syndrome. Which of the
following is a common symptom of this disease?
A. Hematuria
, B. Dysuria
C. Oliguria
D. Proteinuria Correct answer- D
Nephrotic syndrome is manifested by proteinuria
Nephrotic syndrome is diagnosed when the protein level in a 24-hour urine
collection is greater than 3.5 g
A 56-year-old male presents with flank pain and polyuria. Tests reveal that
he has an enlarged prostate. Which of the following types of renal failure
should the nurse monitor for as it is the most likely to occur?
A. Prerenal
B. Intrarenal
C. Extrarenal
D. Postrenal Correct answer- D
the patient will experience postrenal renal failure due to obstruction by the
prostate.
What if the test revealed acute tubular necrosis? intrarenal
While turning a patient with chronic renal failure, which principle should the
nurse recall? Bone fractures are a risk factor in chronic renal failure because:
A. Calcium is lost in the urine
B. Osteoblast activity is excessive
C. The kidneys fail to activate vitamin D
D. Autoantibodies to calcium molecules develop Correct answer- C
Hypocalcemia is accelerated by impaired renal synthesis of vitamin D
The combined effect of vitamin D deficiency can result in renal
osteodystrophies with increased risk for fractures.
A man was mildly confused, and his family brought him to adult day care
during the week. He was incontinent there every day until a nurse suggested
that they put a picture of a toilet on the bathroom door, and he became
continent. What incontinence is this? Correct answer- Functional
Incontinence
A woman has a bladder infection and is distressed to have episodes of
sudden strong need to urinate that cause her to become incontinent. What
incontinence is this? Correct answer- Urge Incontinence
A woman loses a small amount of urine involuntarily every time she sneezes.
What incontinence is this? Correct answer- Stress Incontinence
, A man with a caudal equine involvement in MS became incontinent when his
caregiver was late and was not available to assist with the morning
catheterization. What incontinence is this? Correct answer- Overflow
Incontinence
A 50-year-old male is experiencing reflux of chyme from the stomach. He is
diagnosed with gastroesophageal reflux. This condition is caused by:
A. Fibrosis of lower third of esophagus
B. Sympathetic nerve stimulation
C. Loss of muscle tone at the lower esophageal sphincter
D. Reverse peristalsis of the stomach Correct answer- C
GERD is due to a weak esophageal sphincter
A 22-year-old male underwent brain surgery to remove a tumor. Following
surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _____
ulcer.
A. Infectious
B. Cushing
C. Ischemic
D. Curling Correct answer- B
Cushing ulcer is a stress ulcer associated with severe head trauma or brain
surgery.
Curling ulcers develop secondary to burns.
A 50-year-old male complains of frequently recurring abdominal pain,
diarrhea, and bloody stools. A possible diagnosis would be:
A. Ulcerative colitis
B. Hiatal hernia
C. Pyloric obstruction
D. Achalasia Correct answer- A
Ulcerative colitis is manifested by fever, elevated pulse rate, frequent
diarrhea (10 to 20 stools/day), urgency, obviously bloody stools, and
continuous lesions present in the colon.
Hiatal hernia is most often asymptomatic and would not be manifested by
abdominal pain.
Pyloric obstruction would be manifested by forceful or projectile vomiting.
Achalasia would be manifested by difficulty or uncomfortable swallowing.
A 16-year-old female presents with abdominal pain in the right lower
quadrant. Physical examination reveals rebound tenderness and a low-grade
fever. A possible diagnosis would be:
A. Colon cancer
