Chapter 28: Structure and Function of the Renal and Urologic Systems My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 28: Structure and Function of the Renal and Urologic Systems

Test Bank

MULTIPLE CHOICE

1. A nurse is teaching the staff about the kidneys. Which information should the nurse include? The region of the kidneys that contains the glomeruli is the:

a.

Medulla

b.

Cortex

c.

Pyramids

d.

Columns

ANS: B

The outer layer of the kidney is called the cortex and it contains all of the glomeruli, most of the proximal tubules, and some segments of the distal tubule.

The cortex, not the medulla, contains the glomeruli.

The cortex, not the pyramids, contains the glomeruli.

The cortex, not the columns, contains the glomeruli.

REF: p. 724

2. When the nurse is discussing the functional unit of the kidney, what other term should the nurse use?

a.

Calyx

b.

Nephron

c.

Collecting duct

d.

Pyramid

ANS: B

The functional unit of the kidney is the nephron.

The functional unit of the kidney is the nephron, not the calyx.

The functional unit of the kidney is the nephron, not the collecting duct.

The functional unit of the kidney is the nephron, not the pyramid.

REF: p. 726

3. The urologist is teaching about the nephrons that determine the concentration of the urine. The urologist is discussing the _____ nephrons.

a.

Juxtamedullary

b.

Midcortical

c.

Cortical

d.

Medullary

ANS: A

The juxtamedullary nephrons lie close to and extend deep into the medulla and are important for the concentration of urine.

The juxtamedullary nephrons, not the midcortical nephrons, are important for the concentration of urine.

The juxtamedullary nephrons, not the cortical nephrons, are important for the concentration of urine.

The juxtamedullary nephrons, not the medullary nephrons, are important for the concentration of urine.

REF: p. 726

4. A urologist is discussing the phagocytic cells that lie between the layers of the renal corpuscle. What is the urologist describing?

a.

Podocytes

b.

Macula densa cells

c.

Mesangial cells

d.

Filtration slits

ANS: C

Mesangial cells lie between and support the capillaries. Mesangial cells have phagocytic ability similar to monocytes, release inflammatory cytokines, and can contract to regulate glomerular capillary blood flow.

The epithelium has specialized cells called podocytes from which pedicles (foot projections) radiate and adhere to the basement membrane.

The macula densa are sodium-sensing cells.

The pedicles interlock with the pedicles of adjacent podocytes, forming an elaborate network of intercellular clefts called filtration slits, or slit membranes.

REF: p. 726

5. When the nurse discusses the glomerulus and Bowman capsule together, it is referred to as the renal:

a.

Corpuscle

b.

Capsule

c.

Medulla

d.

Pyramid

ANS: A

Together, the glomerulus and Bowman capsule are called the renal corpuscle.

Together, the glomerulus and Bowman capsule are called the renal corpuscle, not capsule.

Together, the glomerulus and Bowman capsule are called the renal corpuscle, not medulla.

Together, the glomerulus and Bowman capsule are called the renal corpuscle, not pyramid.

REF: p. 726

6. When a nurse is checking the urinalysis, plasma proteins should be absent from the urine because:

a.

All proteins filtered are subsequently reabsorbed.

b.

All of the plasma proteins are too large to fit through the filtration slits.

c.

All proteins filtered are subsequently degraded before elimination.

d.

The negative charge of the glomerular filtration membrane repels the plasma proteins.

ANS: D

Like other capillary membranes, the glomerulus is freely permeable to water and relatively impermeable to large colloids, such as plasma proteins. The molecules size and electrical charge affect the permeability of substances crossing the glomerulus.

Proteins are not filtered because the negative charge of the glomerulus repels them.

Proteins are not filtered because the negative charge of the glomerulus repels them. It is not only because of their size.

Proteins are not filtered because the negative charge of the glomerulus repels them. It is not because of degradation.

REF: p. 726

7. When the nurse is discussing the sodium-sensing cells of the glomerulus, what term should the nurse use?

a.

Podocytes

b.

Macula densa

c.

Mesangial cells

d.

Loop of Henle

ANS: B

The macula densa are sodium-sensing cells.

The epithelium has specialized cells called podocytes from which pedicles (foot projections) radiate and adhere to the basement membrane.

Mesangial cells lie between and support the capillaries. Mesangial cells have phagocytic ability similar to monocytes, release inflammatory cytokines, and can contract to regulate glomerular capillary blood flow.

The loop of Henle is where fluid reabsorption occurs.

REF: p. 726

8. When a nurse is preparing to teach about urine, which information should the nurse include? Just before entering the ureter, urine passes through the:

a.

Collecting duct

b.

Renal pelvis

c.

Urethra

d.

Major calyx

ANS: B

Urine is collected in the renal pelvis and then funneled into the ureters.

Urine is collected in the renal pelvis, not the collecting duct, and then funneled into the ureters.

Urine is collected in the renal pelvis and then funneled into the ureters. The urethra receives urine from the bladder.

Urine is collected in the renal pelvis, not the major calyx, and then funneled into the ureters.

REF: p. 729

9. A urologist is discussing a structure that supplies blood to the medulla. What is the urologist describing?

a.

Renal arteries

b.

Arcuate arteries

c.

Peritubular capillaries

d.

Vasa recta

ANS: D

The vasa recta is a network of capillaries that forms loops and closely follows the loops of Henle and is the only blood supply to the medulla.

The vasa recta is the only blood supply to the medulla. The renal arteries do not meet this need.

The vasa recta is the only blood supply to the medulla. The arcuate arteries do not meet this need.

The vasa recta is the only blood supply to the medulla. The peritubular capillaries do not meet this need.

REF: p. 734

10. A nurse is describing the trigone. Which information should be included? The trigone is defined as:

a.

The orifice of the ureter

b.

The inner area of the kidney

c.

A triangular area between the openings of the two ureters and the urethra

d.

The three divisions of the loop of Henle

ANS: C

The trigone is a smooth triangular area between the openings of the two ureters and the urethra.

The trigone is a smooth triangular area between the openings of the two ureters and the urethra; it is not the orifice of the ureter.

The trigone is a smooth triangular area between the openings of the two ureters and the urethra; it is not the inner area of the kidney.

The trigone is a smooth triangular area between the openings of the two ureters and the urethra; it is not a part of the loop of Henle.

REF: p. 729

11. When describing the male urinary anatomy, which information should the nurse include? The portion of the male urethra that is closest to the bladder is the _____ portion.

a.

Membranous

b.

Prostatic

c.

Cavernous

d.

Vas deferens

ANS: B

In the male, the prostatic urethra is closest to the bladder.

In the male, the prostatic urethra is closest to the bladder; the membranous follows after the prostatic.

In the male, the prostatic urethra is closest to the bladder; the cavernous follows after the membranous.

In the male, the prostatic urethra is closest to the bladder. The vas deferens is not a portion of the male urethra.

REF: p. 729

12. On average the kidneys receive approximately _____ of the cardiac output.

a.

10% to 14%

b.

15% to 19%

c.

20% to 25%

d.

26% to 35%

ANS: C

The kidney receives 20% to 25% of the cardiac output.

The kidney receives 20% to 25%, not 10% to 14% of the cardiac output.

The kidney receives 20% to 25%, not 15% to 19% of the cardiac output.

The kidney receives 20% to 25%, not 26% to 35% of the cardiac output.

REF: p. 729

13. While reviewing urine lab results, the nurse remembers the glomerular filtration rate (GFR) is directly related to the:

a.

Perfusion pressure in the glomerular capillaries

b.

Oncotic pressure in the glomerular capillaries

c.

Vascular resistance in the glomerular arterioles

d.

Hydrostatic pressure in the Bowman capsule

ANS: A

The filtration of the plasma per unit of time is known as the GFR, which is directly related to the perfusion pressure of the glomerular capillaries.

The filtration of the plasma per unit of time is known as the GFR, which is directly related to the perfusion pressure, not the oncotic pressure of the glomerular capillaries.

The filtration of the plasma per unit of time is known as the GFR, which is directly related to the perfusion pressure in the glomerular capillaries, not the vascular resistance in the glomerular arterioles.

The filtration of the plasma per unit of time is known as the GFR, which is directly related to the perfusion pressure in the glomerular capillaries, not the hydrostatic pressure in the Bowman capsule.

REF: p. 729

14. A nurse recalls the blood vessels of the kidneys are innervated by the:

a.

Vagus nerve

b.

Sympathetic nervous system

c.

Somatic nervous system

d.

Parasympathetic nervous system

ANS: B

The blood vessels of the kidney are innervated by the autonomic nervous system through sympathetic fibers.

The blood vessels of the kidney are innervated by the autonomic nervous system through sympathetic fibers, not the vagus nerve.

The somatic system regulates the musculoskeletal system.

The sympathetic system, not the parasympathetic system, innervates the blood vessels of the kidneys.

REF: p. 730

15. While planning care for a patient with urinary problems, the nurse recalls that the renin-angiotensin system will be activated by:

a.

Increased blood volume

b.

Elevated sodium concentrations

c.

Decreased blood pressure in the afferent arterioles

d.

Renal hypertension

ANS: C

The renin-angiotensin system is activated by decreased blood pressure.

Decreased blood pressure, not increased volume, leads to activation of the renin-angiotensin system.

Decreased blood pressure, not elevated sodium, leads to activation of the renin-angiotensin system.

Decreased blood pressure, not hypertension, leads to activation of the renin-angiotensin system.

REF: p. 730

16. When a patients renal system secretes rennin, what effect will that cause in the body? It causes the direct activation of:

a.

Angiotensin I

b.

Angiotensin II

c.

Antidiuretic hormone

d.

Aldosterone

ANS: A

Renin secretion activates angiotensin I.

Renin secretion activates angiotensin I; ACE activates angiotensin II.

Renin secretion activates angiotensin I; it does not activate antidiuretic hormone.

Renin secretion activates angiotensin I; it does not activate aldosterone.

REF: p. 730

17. A nurse is reviewing urinalysis results and notices glucose is present in the urine. A nurse realizes glucose will be excreted in the urine when:

a.

The maximum rate of glucose filtration is achieved

b.

The carrier molecules have reached their maximum

c.

Glucose is consumed

d.

The ability of the kidneys to regulate blood glucose is lost

ANS: B

When the carrier molecules for glucose become saturated (i.e., with the development of hyperglycemia), the excess will be excreted in the urine.

There is not a maximum rate of glucose filtration.

Glucose should not be found in the urine.

The kidneys do not regulate blood glucose.

REF: p. 733

18. When teaching about sodium reabsorption, which information should the nurse include? The majority of sodium reabsorption takes place in the:

a.

Proximal tubule

b.

Loop of Henle

c.

Distal tubule

d.

Collecting duct

ANS: A

The majority of sodium reabsorption takes place in the proximal tubule.

The majority of sodium reabsorption takes place in the proximal tubule, not the loop of Henle.

The majority of sodium reabsorption takes place in the proximal tubule, not the distal tubule.

The majority of sodium reabsorption takes place in the proximal tubule, not the collecting duct.

REF: p. 733

19. A kidney has a glomerular capillary hydrostatic pressure of 50 mm Hg, a Bowman capsule hydrostatic pressure of 15 mm Hg, and a glomerular capillary oncotic pressure of 12 mm Hg. The net filtration pressure is ____ mm Hg.

a.

23

b.

27

c.

35

d.

38

ANS: A

/aAdd the opposing factors: a Bowman capsule hydrostatic pressure of 15 mm Hg, and a glomerular capillary oncotic pressure of 12 mm Hg equals 27 and subtract it from the promoting factor of 50 mm Hg, for a total of 23.

REF: p. 732

20. A nurse is preparing to teach about the loop of Henle. Which information should be included? The descending segment of the loop of Henle primarily allows for:

a.

Sodium secretion

b.

Potassium secretion

c.

Hydrogen ion reabsorption

d.

Water reabsorption

ANS: D

Water reabsorption occurs in the descending segment of the loop of Henle.

Water reabsorption occurs in the loop of Henle; sodium is not affected.

Water reabsorption occurs in the loop of Henle; potassium is not affected.

Water reabsorption occurs in the loop of Henle; hydrogen ion reabsorption does not occur.

REF: p. 734

21. When a staff member asks which of the following substances are actively secreted by the renal tubules, what is the nurses best response?

a.

Sodium and chlorine

b.

Phosphate and calcium

c.

Hydrogen and potassium

d.

Bicarbonate and carbonic acid

ANS: C

Principal cells reabsorb sodium and secrete potassium, and intercalated cells reabsorb potassium and bicarbonate and secrete hydrogen.

Hydrogen and potassium are excreted, not sodium and chlorine.

Hydrogen and potassium are excreted, not phosphate and calcium.

Hydrogen and potassium are excreted, not bicarbonate and carbonic acid.

REF: p. 734

22. A nurse is preparing to teach about the collecting ducts. Reabsorption of water in the collecting ducts requires which of these hormones?

a.

Antidiuretic hormone (ADH)

b.

Atrial natriuretic factor (ANP)

c.

Renin

d.

Aldosterone

ANS: A

ADH increases water permeability and reabsorption in the last segment of the distal tubule and along the entire length of the collecting ducts.

ANP inhibits secretion of renin, inhibits angiotensin-induced secretion of aldosterone, relaxes vascular smooth muscle, and inhibits sodium and water absorption by kidney tubules.

Renin is secreted to raise blood pressure.

Aldosterone regulates water and sodium balance.

REF: p. 734

23. When a patient asks what role the kidneys play in vitamin D function, how should the nurse reply?

a.

Synthesizes vitamin D from cholesterol

b.

Activates intestinally absorbed vitamin D

c.

Metabolizes and breaks down vitamin D

d.

Excretes excess vitamin D

ANS: B

The kidneys play a role in activating intestinally absorbed vitamin D.

The kidneys play a role in activating intestinally absorbed vitamin D. They are not involved in synthesizing vitamin D from cholesterol.

The kidneys play a role in activating intestinally absorbed vitamin D. They are not involved in metabolizing vitamin D.

The kidneys play a role in activating intestinally absorbed vitamin D. They do not excrete excess vitamin D.

REF: p. 736

24. A 35-year-old hypertensive male begins taking a diuretic. Which of the following common side effects of this medication should the nurse monitor?

a.

Hypokalemia

b.

Hyponatremia

c.

Increased uric acid secretion

d.

Hypermagnesemia

ANS: A

Hypokalemia is a side effect of diuretics.

Hypokalemia, not hyponatremia, is a side effect of diuretic therapy.

Diuretics promote uric acid retention, not excretion.

Hypokalemia is a side effect of diuretics. Hypermagnesemia is not.

REF: p. 736

25. A patient has searched the Internet for hormones. The patient has a good understanding when she knows that the hormone _____ is synthesized and secreted by the kidneys to stimulate bone marrow production of red blood cells.

a.

Creatinine

b.

Aldosterone

c.

Erythropoietin

d.

Renin

ANS: C

Erythropoietin stimulates the bone marrow to produce red blood cells in response to tissue hypoxia.

Erythropoietin, not creatinine, stimulates the bone marrow to produce red blood cells in response to tissue hypoxia.

Erythropoietin, not aldosterone, stimulates the bone marrow to produce red blood cells in response to tissue hypoxia.

Erythropoietin, not renin, stimulates the bone marrow to produce red blood cells in response to tissue hypoxia.

REF: p. 736

26. If a nurse wants to obtain the best estimate of renal function, which test should the nurse monitor?

a.

Glomerular filtration rate (GFR)

b.

Circulating antidiuretic hormone (ADH) levels

c.

Volume of urine output

d.

Urine-specific gravity

ANS: A

The GFR provides the best estimate of functioning renal tissue.

The GFR provides the best estimate of functioning renal tissue. Circulating ADH levels is not the best indicator.

The GFR provides the best estimate of functioning renal tissue, not urine output.

The GFR provides the best estimate of functioning renal tissue. Specific gravity is not the best indicator.

REF: p. 736

27. A nurse recalls the glomerular filtration rate (GFR) and plasma creatinine (Pcr) concentration are _____ related.

a.

Directly

b.

Indirectly

c.

Inversely

d.

Not

ANS: C

The GFR and Pcr are inversely related.

The and Pcr are inversely, not directly, related.

The GFR and Pcr are inversely, not indirectly, related.

The GFR and Pcr are inversely related.

REF: p. 737

MULTIPLE RESPONSE

1. When a student asks what the components of the nephron are, how should the nurse respond? The components of the nephron include (select all that apply):

a.

Loop of Henle

b.

Renal corpuscle

c.

Proximal tubule

d.

Renal pelvis

e.

Convoluted tubule

ANS: A, B, C, E

The nephron is a tubular structure with subunits that include the renal corpuscle, proximal convoluted tubule, loop of Henle, distal convoluted tubule, and collecting duct, all of which contribute to the formation of final urine.

REF: p. 726

2. When a staff member asks how the urine gets from the nephrons to the calyces, what is the nurses best response? The renal structure that drains directly into the calyces is (are) the (select all that apply):

a.

Distal tubule

b.

Collecting duct

c.

Pyramid

d.

Renal pelvis

e.

Loop of Henle

ANS: A, B

The urine formed by the nephrons flows from the distal tubules and collecting ducts through the duct of Bellini and the renal papillae into the calyces.

REF: p. 729

COMPLETION

1. A nurse recalls the superficial cortical nephrons account for ____% of all nephrons.

ANS: 85

REF: p. 726

2. On average, _____% of renal plasma flow (RPF) to the glomerulus is filtered into the Bowman capsule.

ANS:

20

From the RPF, 20% (approximately 120 to 140 ml/min) is filtered at the glomerulus and passes into Bowman capsule.

REF: p. 729

3. A nurse would chart a patient is experiencing oliguria when a 24-hour urine output is less than ________.

ANS:

400

Antidiuretic hormone secretion is one cause of oliguria, or diminished excretion of urine, that is less than 400 ml/day or 30 ml/hr.

REF: p. 735

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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