NURS 5315 Exam 3 V2 | NURS 5315
Advanced Pathophysiology | Actual Q&A
with Rationale (NURS5315 Exam 3) | The
University of Texas at Arlington
1. A patient presents with sudden onset of severe flank pain and hematuria. Which of the
following is the most likely pathophysiological mechanism for the formation of calcium
oxalate stones?
A. Excessive production of uric acid in the joints
B. Supersaturation of the urine with stone-forming substances
C. Chronic bacterial infection of the bladder
D. Decreased levels of dietary calcium intake
Answer: B
Rationale: The formation of renal calculi, specifically calcium oxalate stones, begins with
the supersaturation of urine where the concentration of crystals exceeds their solubility.
Once supersaturation occurs, nucleation and crystal growth lead to the formation of a nidus
that can eventually obstruct the urinary tract. Factors such as urinary pH, volume, and the
presence of inhibitors like citrate significantly influence this process.
2. In the progression of chronic kidney disease (CKD), which factor is primarily responsible for
the development of secondary hyperparathyroidism?
A. Loss of negative feedback from the anterior pituitary gland
,B. Direct stimulation of the parathyroid gland by urea
C. Hypercalcemia caused by excessive bone resorption
D. Hypocalcemia resulting from hyperphosphatemia and decreased Vitamin D activation
Answer: D
Rationale: As glomerular filtration rate declines in CKD, the kidneys fail to excrete
phosphate effectively, leading to hyperphosphatemia which binds to serum calcium and
causes hypocalcemia. Additionally, the failing kidneys cannot convert Vitamin D to its
active form, further reducing intestinal calcium absorption. These combined factors trigger
the parathyroid glands to chronically secrete parathyroid hormone in a compensatory
attempt to restore calcium levels.
3. Which clinical manifestation is a hallmark of nephrotic syndrome and distinguishes it from
nephritic syndrome?
A. Gross hematuria and RBC casts
B. Proteinuria exceeding 3.5 grams per day
C. Hypertension due to sodium retention
D. Urgent need for frequent micturition
Answer: B
Rationale: Nephrotic syndrome is characterized by massive proteinuria, typically defined
as more than 3.5 grams of protein lost in the urine over 24 hours. This massive loss is due
, to increased permeability of the glomerular filtration barrier, often resulting in
hypoalbuminemia and generalized edema. In contrast, nephritic syndrome is primarily
associated with inflammatory changes that cause hematuria and variable degrees of
proteinuria.
4. A patient with Acute Kidney Injury (AKI) is found to have an obstruction in the ureter by a
large tumor. This type of AKI is classified as:
A. Prerenal
B. Intrarenal
C. Postrenal
D. Intrinsic
Answer: C
Rationale: Postrenal AKI occurs when there is an obstruction to the flow of urine
anywhere from the renal pelvis down to the urethra. This obstruction increases
intraluminal pressure, which eventually backs up into the Bowman’s capsule and opposes
glomerular filtration. Common causes include prostatic hypertrophy, bilateral ureteral
stones, or pelvic malignancies as seen in this scenario.
5. Which hormone is primarily responsible for the reabsorption of water in the distal
convoluted tubule and collecting duct to maintain fluid balance?
A. Antidiuretic Hormone (ADH)
B. Aldosterone
Advanced Pathophysiology | Actual Q&A
with Rationale (NURS5315 Exam 3) | The
University of Texas at Arlington
1. A patient presents with sudden onset of severe flank pain and hematuria. Which of the
following is the most likely pathophysiological mechanism for the formation of calcium
oxalate stones?
A. Excessive production of uric acid in the joints
B. Supersaturation of the urine with stone-forming substances
C. Chronic bacterial infection of the bladder
D. Decreased levels of dietary calcium intake
Answer: B
Rationale: The formation of renal calculi, specifically calcium oxalate stones, begins with
the supersaturation of urine where the concentration of crystals exceeds their solubility.
Once supersaturation occurs, nucleation and crystal growth lead to the formation of a nidus
that can eventually obstruct the urinary tract. Factors such as urinary pH, volume, and the
presence of inhibitors like citrate significantly influence this process.
2. In the progression of chronic kidney disease (CKD), which factor is primarily responsible for
the development of secondary hyperparathyroidism?
A. Loss of negative feedback from the anterior pituitary gland
,B. Direct stimulation of the parathyroid gland by urea
C. Hypercalcemia caused by excessive bone resorption
D. Hypocalcemia resulting from hyperphosphatemia and decreased Vitamin D activation
Answer: D
Rationale: As glomerular filtration rate declines in CKD, the kidneys fail to excrete
phosphate effectively, leading to hyperphosphatemia which binds to serum calcium and
causes hypocalcemia. Additionally, the failing kidneys cannot convert Vitamin D to its
active form, further reducing intestinal calcium absorption. These combined factors trigger
the parathyroid glands to chronically secrete parathyroid hormone in a compensatory
attempt to restore calcium levels.
3. Which clinical manifestation is a hallmark of nephrotic syndrome and distinguishes it from
nephritic syndrome?
A. Gross hematuria and RBC casts
B. Proteinuria exceeding 3.5 grams per day
C. Hypertension due to sodium retention
D. Urgent need for frequent micturition
Answer: B
Rationale: Nephrotic syndrome is characterized by massive proteinuria, typically defined
as more than 3.5 grams of protein lost in the urine over 24 hours. This massive loss is due
, to increased permeability of the glomerular filtration barrier, often resulting in
hypoalbuminemia and generalized edema. In contrast, nephritic syndrome is primarily
associated with inflammatory changes that cause hematuria and variable degrees of
proteinuria.
4. A patient with Acute Kidney Injury (AKI) is found to have an obstruction in the ureter by a
large tumor. This type of AKI is classified as:
A. Prerenal
B. Intrarenal
C. Postrenal
D. Intrinsic
Answer: C
Rationale: Postrenal AKI occurs when there is an obstruction to the flow of urine
anywhere from the renal pelvis down to the urethra. This obstruction increases
intraluminal pressure, which eventually backs up into the Bowman’s capsule and opposes
glomerular filtration. Common causes include prostatic hypertrophy, bilateral ureteral
stones, or pelvic malignancies as seen in this scenario.
5. Which hormone is primarily responsible for the reabsorption of water in the distal
convoluted tubule and collecting duct to maintain fluid balance?
A. Antidiuretic Hormone (ADH)
B. Aldosterone
