Chapter 29: Alterations of Renal and Urinary Tract Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 29: Alterations of Renal and Urinary Tract Function

Test Bank

MULTIPLE CHOICE

1. 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 the renal pelvis and calyces proximal to a blockage.

d.

stimulation of antidiuretic hormone.

ANS: C

Hydronephrosis occurs due to dilation of the renal pelvis and calyces proximal to a blockage.

Hydronephrosis is not the result of decreased renal blood flow.

Hydronephrosis is not the result of decreased peritubular capillary pressure, but due to dilation of the renal pelvis.

Hydronephrosis occurs due to dilation of the renal pelvis and calyces proximal to a blockage, not to stimulation of the antidiuretic hormone.

REF: p. 741

2. A 27-year-old male has a severe kidney obstruction leading to removal of the affected kidney. Which of the following would the nurse expect to occur?

a.

Atrophy of the remaining kidney

b.

Compensatory hypertrophy of the remaining kidney

c.

Dysplasia in the remaining kidney

d.

Renal failure

ANS: B

The remaining kidney would hypertrophy to compensate for the increased workload of the loss of the affected kidney.

The remaining kidney would enlarge, not atrophy.

The remaining kidney would hypertrophy, not change cell structure.

The remaining kidney would hypertrophy; the patient would not go into renal failure.

REF: p. 742

3. 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

ANS: B

Urine stasis occurs with urinary tract obstruction and can lead to the formation of renal calculi.

Reflux and pyelonephritis would not lead to calculi as much as stasis.

Glomerulonephritis would not lead to calculi formation.

Increased compliance would not lead to calculi.

REF: p. 743

4. When a patient asks what the most common type of renal stones is composed of, how should the nurse respond? The most common type of renal stone is composed of:

a.

magnesium.

b.

struvite.

c.

calcium.

d.

phosphate.

ANS: C

The most common composition of a renal stone is calcium, accounting for 70% to 80%.

The most common composition of a renal stone is calcium, accounting for 70% to 80%. Only a limited number of stones are composed of magnesium.

The most common composition of a renal stone is calcium, accounting for 70% to 80%. Struvite accounts for less than 10% to 15%.

The most common composition of a renal stone is calcium, accounting for 70% to 80%. The percentage of phosphate is very low.

REF: p. 743

5. While planning care for a patient with renal calculi, the nurse remembers the most important factor in renal calculus formation is:

a.

urine pH.

b.

body temperature.

c.

gender.

d.

serum mineral concentrations.

ANS: A

The most important factor in renal calculus formation is urine pH.

The most important factor in renal calculus formation is urine pH, not body temperature.

The most important factor in renal calculus formation is urine pH, not gender, although calculi form more often in men.

The most important factor in renal calculus formation is urine pH, not serum mineral concentrations.

REF: p. 743

6. A 24-year-old female is diagnosed with renal calculus that is causing obstruction. Which of the following symptoms would she most likely experience?

a.

Anuria

b.

Hematuria

c.

Pyuria

d.

Flank pain

ANS: D

Significant flank pain is the most common manifestation.

Anuria does not occur.

Hematuria does occur, but it is not the most common manifestation.

Flank pain is the most common symptom; pyuria does not occur.

REF: p. 743

7. A 25-year-old female presents with burning urination. She was diagnosed with a urinary tract infection. When the nurse checks the culture results, which of the following organisms is most likely infecting her urinary tract?

a.

Streptococcus

b.

Candida albicans

c.

Chlamydia

d.

Escherichia coli

ANS: D

The most common infecting microorganisms are uropathic strains of Escherichia coli.

The most common infecting microorganisms are uropathic strains of Escherichia coli. Streptococcus in not a factor.

The most common infecting microorganisms are uropathic strains of Escherichia coli, not Candida albicans.

The most common infecting microorganisms are uropathic strains of Escherichia coli, not Chlamydia.

REF: p. 748

8. A 35-year-old male received a traumatic brain injury in a motor vehicle accident. CT scan revealed a lesion above the pontine micturition center. Which of the following would the nurse expect?

a.

Dyssynergia

b.

Detrusor hyperreflexia

c.

Detrusor areflexia

d.

Detrusor sphincter dyssynergia

ANS: B

Neurologic disorders that develop above the pontine micturition center result in detrusor hyperreflexia, also known as an uninhibited or reflex bladder.

Lesions that develop in upper motor neurons of the brain and spinal cord result in dyssynergia.

Lesions that involve the sacral micturition center (below S1; may also be termed cauda equina syndrome) or peripheral nerve lesions result in detrusor areflexia (acontractile detrusor), a lower motor neuron disorder.

Neurologic lesions that occur below the pontine micturition center but above the sacral micturition center (between C2 and S1) are also upper motor neuron lesions and result in detrusor hyperreflexia with vescico-sphincter dyssynergia.

REF: p. 744

9. 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.

Stress incontinence

c.

Overflow incontinence

d.

Functional incontinence

ANS: B

Reduced resistance is associated with the symptom of stress incontinence, which is incontinence with coughing or sneezing.

Urge incontinence is the inability to hold the urine when the urge is felt.

There is coordination between the contracting bladder and the external sphincter, but the detrusor is too weak to empty the bladder, resulting in urinary retention with overflow or stress incontinence.

Functional incontinence is similar to overflow and is not associated with coughing.

REF: p. 745

10. A 19-year-old female was involved in a motor vehicle accident during which she sustained a closed head injury. She is now experiencing detrusor sphincter dyssynergia. Which of the following is the most beneficial medication treatment?

a.

Alpha blocker

b.

Beta blocker

c.

Vasodilator

d.

Diuretic

ANS: A

Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications.

Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications, not beta blockers.

Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications, not a vasodilator.

Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by alpha-adrenergic blocking (antimuscarinic) medications, not a diuretic.

REF: p. 746

11. A nurse assesses a patient with a complicated urinary tract infection (UTI) for:

a.

Several species of bacteria

b.

Other health problems

c.

Urosepsis

d.

Rrethral obstruction

ANS: B

A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses or response to treatment. UTI may occur alone or in association with pyelonephritis, prostatitis, or kidney stones.

A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses or response to treatment. UTI may occur alone or in association with pyelonephritis, prostatitis, or kidney stones. It is not due to the involvement of several species of bacteria.

A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses or response to treatment. UTI may occur alone or in association with pyelonephritis, prostatitis, or kidney stones. It does not always cause urosepsis.

A complicated UTI develops when there is an abnormality in the urinary system or a health problem that compromises host defenses or response to treatment. UTI may occur alone or in association with pyelonephritis, prostatitis, or kidney stones. It does not always result in obstruction.

REF: p. 747

12. A 28-year-old female presents with fever, chills, and flank pain. She is diagnosed with pyelonephritis. A nurse recalls the patients infection is located in the:

a.

Bladder

b.

Renal pelvis

c.

Renal tubules

d.

Glomerulus

ANS: B

Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium).

Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium). It does not affect the bladder.

Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium). It does not affect the tubules.

Pyelonephritis is an infection of one or both upper urinary tracts (ureter, renal pelvis, and interstitium). It does not involve the glomerulus.

REF: p. 749

13. While planning care for a patient who has acute pyelonephritis. A nurse recalls the most common condition associated with the development of acute pyelonephritis is:

a.

Cystitis

b.

Renal cancer

c.

Urinary tract obstruction

d.

Nephrotic syndrome

ANS: C

Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors.

Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors. Cystitis is not a common risk factor.

Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors. Renal cancer is not a common risk factor.

Urinary obstruction and reflux of urine from the bladder are the most common underlying risk factors. Nephrotic syndrome is not a common risk factor.

REF: p. 749

14. 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

ANS: A

The patient is demonstrating symptoms of acute cystitis.

Although renal calculi can cause pain and hematuria, it is not manifested by fever and cloudy urine.

Chronic renal failure is not manifested by cloudy urine.

Postrenal renal failure is not manifested by hematuria and cloudy urine.

REF: p. 747

15. A 15-year-old male was diagnosed with pharyngitis. Eight days later he developed acute glomerulonephritis. While reviewing the culture results, which of the following is the most likely cause of this disease?

a.

Klebsiella

b.

Human immunodeficiency virus (HIV)

c.

Genital herpes virus

d.

Group A -hemolytic streptococcus

ANS: D

Group A -hemolytic streptococcus is the primary cause of glomerulonephritis associated with a pharyngeal infection.

Group A -hemolytic streptococcus is the primary cause of glomerulonephritis associated with a pharyngeal infection. Klebsiella is not associated with pharyngitis.

Group A -hemolytic streptococcus is the primary cause of glomerulonephritis associated with a pharyngeal infection. HIV is not associated with pharyngitis.

Group A -hemolytic streptococcus is the primary cause of glomerulonephritis associated with a pharyngeal infection. Genital herpes is not associated with pharyngitis.

REF: p. 753

16. A 25-year-old male was diagnosed with Goodpasture syndrome. While planning care for this patient, which of the following mechanisms would cause tissue injury?

a.

Viral infection of the Bowman capsule

b.

Production of antibodies against the glomerular basement membrane

c.

Antigen-antibody complex deposition with complement activation

d.

Abnormal activation of clotting factors and microclotting in the glomerulus

ANS: B

Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with antibody formation against both pulmonary capillary and glomerular basement membranes.

Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with antibody formation against both pulmonary capillary and glomerular basement membranes. It is not due to a viral infection.

Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with antibody formation against both pulmonary capillary and glomerular basement membranes. It is not an antigen-antibody complex.

Antiglomerular basement membrane disease (Goodpasture syndrome) is associated with antibody formation against both pulmonary capillary and glomerular basement membranes. It is not due to abnormal clotting.

REF: p. 752

17. When a nurse observes poststreptococcal glomerulonephritis as a diagnosis on a patient, which principle will the nurse remember? Acute poststreptococcal glomerulonephritis is primarily caused by:

a.

Swelling of mesangial cells in the Bowman space in response to the presence of bacteria

b.

Antigen-antibody complex deposition in the glomerular capillaries and inflammatory damage

c.

Inflammatory factors that stimulate cellular proliferation of epithelial cells

d.

Accumulation of antiglomerular basement membrane antibodies

ANS: B

Acute poststreptococcal glomerulonephritis is caused by an antigen-antibody complex.

Acute poststreptococcal glomerulonephritis is not due to swelling of the Bowman space.

Acute poststreptococcal glomerulonephritis is caused by an antigen-antibody complex. It is not an inflammatory process.

Acute poststreptococcal glomerulonephritis is caused by an antigen-antibody complex.

REF: p. 752

18. 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

ANS: C

Two major symptoms distinctive of more severe glomerulonephritis are: (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein.

Cystitis is not a symptom of glomerulonephritis.

Chronic pyelonephritis is manifested by dysuria, not proteinuria.

Proteinuria is not seen with renal calculi.

REF: p. 751

19. A 45-year-old male presents with oliguria. He is diagnosed with chronic glomerulonephritis. The nurse knows oliguria is related to:

a.

Thickening of the glomerular membrane and decreased renal blood flow

b.

Increased glomerular capillary oncotic pressure and tubular obstruction

c.

Activation of renin-angiotensin from decreased blood volume

d.

Vasoconstriction of the efferent arterioles

ANS: A

Changes in the glomerulus are characterized by progressive thickening and fibrosis of the glomerular basement membrane.

Changes in the glomerulus are characterized by progressive thickening and fibrosis of the glomerular basement membrane; there is not tubular obstruction.

The renin-angiotensin system is not activated in glomerulonephritis.

The efferent arterioles are not affected in glomerulonephritis.

REF: p. 751

20. 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

ANS: 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.

Proteinuria is the diagnostic criteria for nephrotic syndrome.

The patient with nephrotic syndrome does not experience dysuria.

The patient with nephrotic syndrome does not experience oliguria.

REF: p. 753

21. A 42-year-old male is involved in a motor vehicle accident during which he loses a lot of blood. The nurse realizes he is in acute renal failure caused by:

a.

Kidney stones

b.

Immune complex deposition in the glomerulus

c.

Inadequate renal blood flow

d.

Obstruction of the proximal tubule

ANS: C

With blood loss, renal failure is due to inadequate blood flow.

Kidney stones will lead to postrenal renal failure.

Intrarenal renal failure is due to glomerular nephritis.

Blood loss would not cause obstruction of the proximal tubule.

REF: p. 754

22. A 35-year-old female was severely burned and is hospitalized. She is now suffering from acute tubular necrosis (ATN). Which of the following is the most likely diagnosis the nurse will observe on the chart?

a.

Prerenal

b.

Intrarenal

c.

Extrarenal

d.

Postrenal

ANS: B

Intrarenal acute kidney failure is associated with several systemic diseases but is commonly related to ATN.

Prerenal renal failure occurs anterior to the kidney.

Extrarenal renal failure occurs outside the kidney.

Postrenal is due to diseases that obstruct the flow of urine from the kidneys.

REF: p. 755

23. 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

ANS: D

The patient will experience postrenal renal failure due to obstruction by the prostate.

The patient will experience postrenal renal failure due to obstruction by the prostate.

The patient will experience postrenal renal failure due to obstruction by the prostate.

The patient will experience postrenal renal failure due to obstruction by the prostate.

REF: p. 755

24. A 60-year-old male is diagnosed with renal failure. While the nurse is reviewing lab results, which of the following lab values would be most consistent with this diagnosis?

a.

Elevated plasma creatinine level

b.

Decreased plasma potassium level

c.

Metabolic alkalosis

d.

Increased urea clearance

ANS: A

Creatinine is constantly released from muscle and excreted primarily by glomerular filtration. In chronic kidney disease (CKD), as glomerular filtration rate (GFR) declines, the plasma creatinine level increases by a reciprocal amount to maintain a constant rate of excretion. As GFR continues to decline, plasma creatinine concentration increases.

Creatinine is elevated; potassium is also elevated.

Metabolic acidosis develops.

Decreased urea clearance occurs.

REF: p. 756

25. A 45-year-old female presents with hypertension, anorexia, nausea and vomiting, and anemia. She is diagnosed with chronic renal failure. When the patient asks what caused this anemia, how should the nurse respond? Your anemia is caused by:

a.

Red blood cells being lost in the urine

b.

Inadequate production of erythropoietin

c.

Inadequate iron absorption in the gut

d.

Red blood cells being injured as they pass through the glomerulus

ANS: B

The kidneys are inadequate in their production of erythropoietin.

The kidneys are inadequate in their production of erythropoietin; red cells may be lost in the urine, but it is the lack of erythropoietin that leads to anemia.

The kidneys are inadequate in their production of erythropoietin; it is not due to inadequate iron absorption.

The kidneys are inadequate in their production of erythropoietin; it is not due to red cell destruction.

REF: p. 758

26. A 42-year-old female is diagnosed with chronic renal failure, and the nurse is discussing dietary treatment. Which information indicates the nurse understands dietary regimen? Treatment includes restricting:

a.

Fats

b.

Complex carbohydrates

c.

Proteins

d.

Sugars

ANS: C

Low-protein diets are recommended.

Low-protein diets, not reduced fats, are recommended.

Low-protein diets, not reduced carbohydrates, are recommended.

Low-protein diets, not reduced sugars, are recommended.

REF: p. 760

27. 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.

ANS: C

Hypocalcemia is accelerated by impaired renal synthesis of 1,25-vitamin D. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures.

Hypocalcemia is accelerated by impaired renal synthesis of 1,25-vitamin D. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. Calcium is not lost in the urine.

Hypocalcemia is accelerated by impaired renal synthesis of 1,25-vitamin D. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. Osteoblast activity is not accelerated.

Hypocalcemia is accelerated by impaired renal synthesis of 1,25-vitamin D. The combined effect of vitamin D deficiency can result in renal osteodystrophies with increased risk for fractures. Antibodies do not develop.

REF: p. 760

28. Anemia accompanies chronic renal failure because of:

a.

Blood loss via the urine

b.

Renal insensitivity to vitamin D

c.

Inadequate production of erythropoietin

d.

Inadequate retention of serum iron

ANS: C

Chronic renal failure leads to anemia because of declining erythropoietin production.

Chronic renal failure leads to anemia because of declining erythropoietin production. It is not due to blood loss.

Chronic renal failure leads to anemia because of declining erythropoietin production. It is not due to insensitivity to vitamin D.

Chronic renal failure leads to anemia because of declining erythropoietin production. It is not due to inadequate retention of serum iron.

REF: p. 760

29. A patient with end-stage renal disease has pruritus. When the patient asks what causes this, what is the nurses best response? Pruritus, seen in patients with end-stage renal disease, is caused by high levels of:

a.

Potassium

b.

Calcium

c.

Sodium

d.

Magnesium

ANS: B

Pruritus is related to high levels of calcium.

Pruritus is related to high levels of calcium, not potassium.

Pruritus is related to high levels of calcium, not sodium.

Pruritus is related to high levels of calcium, not magnesium.

REF: p. 760

MULTIPLE RESPONSE

1. When a nurse is teaching about urinary pathogens in men. Which information should the nurse include? Mechanisms for defense against urinary pathogens in men include (select all that apply):

a.

The long length of the urethra

b.

Alkaline pH of urine

c.

Secretion of mucus that traps bacteria

d.

Antimicrobial secretions from the prostate

e.

Implantation of the ureters in the bladder

ANS: A, D

Both the longer urethra and prostatic secretions decrease the risk of infection in men. The urine is not more alkaline, and they do not secrete mucus that traps bacteria. The ureters in men and women are implanted in similar positions and in their normal position; it is not a factor in the development of cystitis.

REF: p. 747

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