,Section I: Renal & Urinary Disorders (Questions 1–50)
Q1. A patient presents with hypertension, edema, hematuria, and cola-colored urine following a recent
streptococcal throat infection. Which condition is most likely?
• A) Acute pyelonephritis
• B) Acute glomerulonephritis
• C) Nephrotic syndrome
• D) Polycystic kidney disease
Correct Answer: B — Acute glomerulonephritis
Rationale: Acute postinfectious glomerulonephritis typically follows a Group A beta-hemolytic
streptococcal infection of the throat (pharyngitis) or skin (impetigo). The classic presentation includes
hypertension, edema, hematuria, and cola-colored urine due to glomerular inflammation and red blood
cell leakage. Acute pyelonephritis presents with fever and flank pain; nephrotic syndrome presents with
massive proteinuria and hypoalbuminemia; polycystic kidney disease manifests with gradual renal
function decline in adulthood.
Q2. Nephrotic syndrome does NOT usually cause which of the following?
• A) Hyperlipidemia
• B) Proteinuria
• C) Hematuria
• D) Generalized edema
Correct Answer: C — Hematuria
Rationale: Nephrotic syndrome is characterized by increased glomerular permeability due to damage to
podocytes, resulting in massive proteinuria (>3.5 g/24h). This leads to hypoalbuminemia, generalized
edema, and hyperlipidemia (the liver synthesizes excessive lipids). Hematuria is characteristic of
nephritic syndrome, not nephrotic syndrome. In nephrotic syndrome, the urine typically contains large
amounts of protein but few red blood cells.
Q3. When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of
protein?" the nurse's response is based on the knowledge that:
• A) His glomeruli have been damaged by his own immune system
• B) The glomerular membrane has increased permeability
• C) His liver is extremely active in synthesizing protein
• D) His renal tubules are full of cellular debris
Correct Answer: B — The glomerular membrane has increased permeability
,Rationale: In nephrotic syndrome, the primary pathophysiologic mechanism is increased permeability of
the glomerular membrane, specifically damage to podocytes. This allows large amounts of albumin to be
lost in the urine, leading to hypoalbuminemia. The liver may attempt to compensate, but albumin loss
exceeds production.
Q4. The pathophysiologic basis of acute glomerulonephritis is:
• A) Renal ischemia
• B) Bacterial invasion of the glomerulus
• C) An anaphylactic reaction
• D) An immune complex reaction
Correct Answer: D — An immune complex reaction
Rationale: Acute glomerulonephritis is typically an immune-complex mediated disease. The immune
complexes deposit in the glomeruli, triggering inflammation. This is most commonly associated with
Group A beta-hemolytic streptococcal infection.
Q5. A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-
streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?" the nurse's best
response is:
• A) "Normally, red blood cells that enter the urine are taken back into the blood, but in your
condition, they stay in the urine."
• B) "Your immune system was activated by your sore throat and has caused some damage in
your kidneys that allows red blood cells to leak into your urine."
• C) "The bacteria that caused your sore throat have traveled to your kidneys and are causing
damage there."
• D) "When parts of your kidneys stopped working, your blood kept flowing and broke some of
your little blood vessels."
Correct Answer: B — "Your immune system was activated by your sore throat and has caused some
damage in your kidneys that allows red blood cells to leak into your urine."
Rationale: This response accurately explains the immune-complex mechanism of post-streptococcal
glomerulonephritis in patient-friendly terms. The immune response to the streptococcal infection leads
to deposition of immune complexes in the glomeruli, causing inflammation and allowing red blood cells
to leak into the urine.
Q6. Which laboratory finding is most suggestive of glomerulonephritis rather than nephrotic syndrome?
• A) Serum albumin 2.8 g/dL
• B) 24-hour urine protein 4.5 g
• C) Red blood cell casts in urine
, • D) Serum cholesterol 320 mg/dL
Correct Answer: C — Red blood cell casts in urine
Rationale: RBC casts indicate glomerular bleeding, characteristic of glomerulonephritis. Nephrotic
syndrome typically shows fatty casts and oval fat bodies with protein but without significant hematuria.
Low albumin, massive proteinuria, and hyperlipidemia are features of nephrotic syndrome.
Q7. The finding of white blood cell casts in the urine is indicative of:
• A) Glomerulonephritis
• B) Pyelonephritis
• C) Nephrotic syndrome
• D) Renal calculi
Correct Answer: B — Pyelonephritis
Rationale: White blood cell casts in the urine indicate pyelonephritis (inflammation of the renal pelvis
and kidney). Red blood cell casts indicate glomerulonephritis. Fatty casts suggest nephrotic syndrome.
Crystals may be seen with renal calculi.
Q8. A person with acute pyelonephritis would most typically experience:
• A) Oliguria
• B) Hypertension
• C) Fever
• D) Periorbital edema
Correct Answer: C — Fever
Rationale: Acute pyelonephritis is a severe infection of the kidney that typically presents with systemic
signs including fever, chills, and costovertebral angle (CVA) tenderness. Oliguria and periorbital edema
are more characteristic of glomerulonephritis or renal failure.
Q9. The organism most commonly associated with acute pyelonephritis is:
• A) Streptococcus
• B) Escherichia coli
• C) Klebsiella
• D) Enterobacter
Correct Answer: B — Escherichia coli
Rationale: Escherichia coli is the most common causative organism of acute pyelonephritis, accounting
for the majority of cases. It typically ascends from the lower urinary tract.
Q1. A patient presents with hypertension, edema, hematuria, and cola-colored urine following a recent
streptococcal throat infection. Which condition is most likely?
• A) Acute pyelonephritis
• B) Acute glomerulonephritis
• C) Nephrotic syndrome
• D) Polycystic kidney disease
Correct Answer: B — Acute glomerulonephritis
Rationale: Acute postinfectious glomerulonephritis typically follows a Group A beta-hemolytic
streptococcal infection of the throat (pharyngitis) or skin (impetigo). The classic presentation includes
hypertension, edema, hematuria, and cola-colored urine due to glomerular inflammation and red blood
cell leakage. Acute pyelonephritis presents with fever and flank pain; nephrotic syndrome presents with
massive proteinuria and hypoalbuminemia; polycystic kidney disease manifests with gradual renal
function decline in adulthood.
Q2. Nephrotic syndrome does NOT usually cause which of the following?
• A) Hyperlipidemia
• B) Proteinuria
• C) Hematuria
• D) Generalized edema
Correct Answer: C — Hematuria
Rationale: Nephrotic syndrome is characterized by increased glomerular permeability due to damage to
podocytes, resulting in massive proteinuria (>3.5 g/24h). This leads to hypoalbuminemia, generalized
edema, and hyperlipidemia (the liver synthesizes excessive lipids). Hematuria is characteristic of
nephritic syndrome, not nephrotic syndrome. In nephrotic syndrome, the urine typically contains large
amounts of protein but few red blood cells.
Q3. When a patient experiencing nephrotic syndrome asks, "What causes my urine to be so full of
protein?" the nurse's response is based on the knowledge that:
• A) His glomeruli have been damaged by his own immune system
• B) The glomerular membrane has increased permeability
• C) His liver is extremely active in synthesizing protein
• D) His renal tubules are full of cellular debris
Correct Answer: B — The glomerular membrane has increased permeability
,Rationale: In nephrotic syndrome, the primary pathophysiologic mechanism is increased permeability of
the glomerular membrane, specifically damage to podocytes. This allows large amounts of albumin to be
lost in the urine, leading to hypoalbuminemia. The liver may attempt to compensate, but albumin loss
exceeds production.
Q4. The pathophysiologic basis of acute glomerulonephritis is:
• A) Renal ischemia
• B) Bacterial invasion of the glomerulus
• C) An anaphylactic reaction
• D) An immune complex reaction
Correct Answer: D — An immune complex reaction
Rationale: Acute glomerulonephritis is typically an immune-complex mediated disease. The immune
complexes deposit in the glomeruli, triggering inflammation. This is most commonly associated with
Group A beta-hemolytic streptococcal infection.
Q5. A patient who reported a very painful sore throat 3 weeks ago is now diagnosed with acute post-
streptococcal glomerulonephritis. When asked, "Why is my urine the color of coffee?" the nurse's best
response is:
• A) "Normally, red blood cells that enter the urine are taken back into the blood, but in your
condition, they stay in the urine."
• B) "Your immune system was activated by your sore throat and has caused some damage in
your kidneys that allows red blood cells to leak into your urine."
• C) "The bacteria that caused your sore throat have traveled to your kidneys and are causing
damage there."
• D) "When parts of your kidneys stopped working, your blood kept flowing and broke some of
your little blood vessels."
Correct Answer: B — "Your immune system was activated by your sore throat and has caused some
damage in your kidneys that allows red blood cells to leak into your urine."
Rationale: This response accurately explains the immune-complex mechanism of post-streptococcal
glomerulonephritis in patient-friendly terms. The immune response to the streptococcal infection leads
to deposition of immune complexes in the glomeruli, causing inflammation and allowing red blood cells
to leak into the urine.
Q6. Which laboratory finding is most suggestive of glomerulonephritis rather than nephrotic syndrome?
• A) Serum albumin 2.8 g/dL
• B) 24-hour urine protein 4.5 g
• C) Red blood cell casts in urine
, • D) Serum cholesterol 320 mg/dL
Correct Answer: C — Red blood cell casts in urine
Rationale: RBC casts indicate glomerular bleeding, characteristic of glomerulonephritis. Nephrotic
syndrome typically shows fatty casts and oval fat bodies with protein but without significant hematuria.
Low albumin, massive proteinuria, and hyperlipidemia are features of nephrotic syndrome.
Q7. The finding of white blood cell casts in the urine is indicative of:
• A) Glomerulonephritis
• B) Pyelonephritis
• C) Nephrotic syndrome
• D) Renal calculi
Correct Answer: B — Pyelonephritis
Rationale: White blood cell casts in the urine indicate pyelonephritis (inflammation of the renal pelvis
and kidney). Red blood cell casts indicate glomerulonephritis. Fatty casts suggest nephrotic syndrome.
Crystals may be seen with renal calculi.
Q8. A person with acute pyelonephritis would most typically experience:
• A) Oliguria
• B) Hypertension
• C) Fever
• D) Periorbital edema
Correct Answer: C — Fever
Rationale: Acute pyelonephritis is a severe infection of the kidney that typically presents with systemic
signs including fever, chills, and costovertebral angle (CVA) tenderness. Oliguria and periorbital edema
are more characteristic of glomerulonephritis or renal failure.
Q9. The organism most commonly associated with acute pyelonephritis is:
• A) Streptococcus
• B) Escherichia coli
• C) Klebsiella
• D) Enterobacter
Correct Answer: B — Escherichia coli
Rationale: Escherichia coli is the most common causative organism of acute pyelonephritis, accounting
for the majority of cases. It typically ascends from the lower urinary tract.
