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BAngiotensin II activity is elevated with progressive nephron injury. This selection is the only accurate identification of the effect of progressive nephron injury on angiotensin II activity.
Which mineral accounts for the most common type of renal stone?a. Magnesium-ammonium-phosphate b. Uric acid c. Calcium oxalated. Magnesium phosphate
CCalcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all stones requiring t
Regarding the formation of renal calculi, what function does pyrophosphate, potassium citrate, and magnesium perform?a. They inhibit crystal growth.b. Pyrophosphate, potassium citrate, and magnesium stimulate the supersaturation of salt.c. They facilitate the precipitation of salts from a liquid to a solid state.d. Pyrophosphate, potassium citrate, and magnesium enhance crystallization of salt crystals to form stones.
AStone or crystal growth inhibiting substances, including potassium citrate, pyrophosphate, and magnesium, are capable of crystal growth inhibition. They are not capable of the functions stated by the other options.
Hypercalciuria is primarily attributable to which alteration?a. Defective renal calcium reabsorptionb. Intestinal hyperabsorption of dietary calciumc. Bone demineralization caused by prolonged immobilizationd. Hyperparathyroidism
BHypercalciuria is usually attributable to intestinal hyperabsorption of dietary calcium and less commonly to a defect in renal calcium reabsorption. Hyperparathyroidism and bone demineralization associated with prolonged immobilization are also known to cause hypercalciuria but too a much lesser degree.
Detrusor hyperreflexia develops from neurologic disorders that originate where?a. Spinal cord between C2 and S1 b. Spinal cord between S2 and S4 c. Above the pontine micturition centerd. Below the cauda equina
CNeurologic disorders that develop above the pontine micturition center result in detrusor hyperreflexia, also known as an uninhibited or reflex bladder. This selection is the only option responsible for detrusor hyperreflexia.
Considering the innervation of the circular muscles of the bladder neck, which classification of drug is used to treat bladder neck obstruction?a. -Adrenergic blocking medications b. -Adrenergic blocking medications c. Parasympathomimetic medicationsd. Anticholinesterase medications
BBecause the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by -adrenergic blocking (antimuscarinic) medications. This selection is the only option capable of this specific function.
Renal cell carcinoma, classified as clear cell tumors, arises from epithelial cells in which structure?a. Proximal tubule c. Nephronb. Distal tubule d. Glomerulus
ARenal cell carcinoma, classified as clear cell tumors according to cell type and extent of metastasis, arises from the proximal tubular epithelium. These tumors are not associated with the other options.
Bladder cancer is associated with the gene mutation of which gene?a. c-erbB2b. Human epidermal growth factor receptor 2 (HER2)c. TP53d. myc
COncogenes of the ras gene family and tumor-suppressor genes including TP53 mutations and the inactivation of the retinoblastoma gene (pRb) are implicated in bladder cancer. This process is not associated with the other options.
What is the most common cause of uncomplicated urinary tract infections?a. Staphylococcus c. Proteusb. Klebsiella d. Escherichia coli
DThe most common infecting microorganisms are uropathic strains of E. coli (80% to 85%).
Which differentiating sign is required to make the diagnosis of pyelonephritis from that of cystitis?a. Difficulty starting the stream of urineb. Spasmodic pain that radiates to the groinc. Increased glomerular filtration rated. Urinalysis confirmation of white blood cell casts
DClinical assessment, alone, is difficult to differentiate the symptoms of cystitis from those of pyelonephritis. Urine culture, urinalysis, and clinical signs and symptoms establish the specific diagnosis. White blood cell casts indicate pyelonephritis, but they are not always present in the urine. This selection is the only option that is considered a required sign of pyelonephritis.
Considering host defense mechanisms, which element in the urine is bacteriostatic?a. High pH (alkaline urine) b. High urea c. High glucosed. High calcium
BDilute urine washes out bacteria, and urine with higher urea concentrations (high osmolarity) is more bacteriostatic.
Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?a. Confusion and poorly localized abdominal discomfortb. Dysuria, frequency, and suprapubic painc. Hematuria and flank paind. Pyuria, urgency, and frequency
AOlder adults with cystitis may demonstrate confusion or vague abdominal discomfort or otherwise be asymptomatic.
Pyelonephritis is usually caused by which type of organism?a. Bacteria c. Virusesb. Fungi d. Parasites
APyelonephritis is usually caused by the bacteria Escherichia coli, Proteus, or Pseudomonas.
Which abnormal laboratory value is found in glomerular disorders?a. Elevated creatinine concentration b. Low blood urea nitrogen (BUN) c. Elevated immunoglobulin A (IgA)d. Low serum complement
AElevated creatinine concentration is an abnormal laboratory value found in glomerular disorders. Reduced glomerular filtration rate during glomerular disease is evidenced by elevated plasma urea, creatinine concentration, or reduced renal creatinine clearance. Glomerular disorders are not associated with the other options.
Which glomerular lesion is characterized by thickening of the glomerular capillary wall with immune deposition of immunoglobulin G (IgG) and C3?a. Proliferative c. Mesangialb. Membranous d. Crescentic
BThe thickening of the glomerular capillary wall characterizes only membranous lesions.
Goodpasture syndrome is an example of which of the following?a. Antiglomerular basement membrane diseaseb. Acute glomerulonephritisc. Chronic glomerulonephritisd. Immunoglobulin A (IgA) nephropathy
AAntiglomerular basement membrane disease (Goodpasture syndrome) is associated with immunoglobulin G (IgG) antibody formation against pulmonary capillary and glomerular basement membranes. Goodpasture syndrome is not an example of any of the other options.
A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence of which disorder?a. Cystitis b. Chronic pyelonephritis c. Glomerulonephritisd. Nephrotic syndrome
CThe data suggest the patient has the disorder known as glomerulonephritis. Two major changes distinctive of more severe glomerulonephritis are (1) hematuria with red blood cell casts and (2) proteinuria exceeding 3 to 5 g/day with albumin as the major protein. These symptoms do not support the diagnosis of the other options.
Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder?a. Nephrotic syndrome b. Acute glomerulonephritis c. Chronic glomerulonephritisd. Pyelonephritis
ASymptoms of nephrotic syndrome include edema, hyperlipidemia, lipiduria, vitamin D deficiency, and hypothyroidism. These symptoms do not support the other options.
Which antibiotics are considered “major culprits” in causing nephrotoxic acute tubular necrosis (ATN)?a. Penicillin and ampicillin b. Vancomycin and bacitracin c. Gentamicin and tobramycind. Cefazolin and cefepime
CAlthough numerous antibiotics can produce nephrotoxic ATN, the aminoglycosides (gentamicin, tobramycin) are the major culprits.
Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?a. Urine sodium >30 mEq/Lb. Urine osmolality >500 mOsmc. Fractional excretion of sodium (FENa)
AUrine sodium >30 mEq/L is the only option indicative of ATN.
How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?a. Glucose has an osmotic effect, which attracts water and sodium, resulting in more dilute blood and a lower potassium concentration.b. When insulin transports glucose into the cell, it also carries potassium with it.c. Potassium attaches to receptors on the cell membrane of glucose and is carried into the cell.d. Increasing insulin causes ketoacidosis, which causes potassium to move into the cell in exchange for hydrogen.
BThis selection is the only option that accurately describes glucose metabolism, causing potassium to move to the intracellular fluid; insulin infusions therefore can be effective in shifting potassium from the extracellular to intracellular space, along with the transport of glucose.
Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue?a. Nervous system c. Muscleb. Kidneys d. Liver
CCreatinine is constantly released from only muscle tissue to be excreted by glomerular filtration.
Which statement is false concerning the skeletal alterations caused by chronic renal failure when the glomerular filtration rate (GFR) declines to 25% of normal?a. Parathyroid hormone is no longer effective in maintaining serum phosphate levels.b. The parathyroid gland is no longer able to secrete sufficient parathyroid hormone.c. The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium, is impaired.d. The synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone, is impaired.
BBone and skeletal changes develop with alterations in calcium and phosphate metabolism (see Table 38-16). These changes begin when the GFR decreases to 25% or less. The combined effect of hyperparathyroidism and vitamin D deficiency can result in renal osteodystrophies (e.g., osteomalacia, osteitis fibrosa with increased risk for fractures). Other consequences of secondary hyperparathyroidism include soft-tissue and vascular calcification, cardiovascular disease, and, less commonly, calcific uremic arteriolopathy. The other options are true.
Anemia of chronic renal failure can be successfully treated with which element?a. Intrinsic factor c. Vitamin Db. Vitamin B12 d. Erythropoietin
DAnemia of chronic renal failure can be successfully treated with erythropoietin. Reduced erythropoietin secretion and reduced red cell production are evident in anemia resulting from chronic renal failure. The other options are not relevant to this condition.
When the right kidney is obstructed, how will the glomeruli and tubules in the left kidney compensate?a. Increase in number b. Increase in size c. Develop collateral circulationd. Increase speed of production
BThese processes cause the contralateral (unobstructed) kidney to increase the size of individual glomeruli and tubules. The changes described by the other options are not correct.
What medical term is used to identify a functional urinary tract obstruction caused by an interruption of the nerve supply to the bladder?a. Neurogenic bladder c. Necrotic bladderb. Obstructed bladder d. Retrograde bladder
ANeurogenic bladder is a general term for bladder dysfunction caused by neurologic disorders. The types of dysfunction are related to the sites in the nervous system that control sensory and motor bladder function (see Figure 38-3). None of the other options correctly identify the described condition.
In glomerulonephritis, what damages the epithelial cells resulting in proteinuria? (Select all that apply.)a. Ischemiab. Lysosomal enzymesc. Compression from edemad. Activated complemente. Altered membrane permeability
D, EActivated complement, inflammatory cytokines, oxidants, proteases, and growth factors attack epithelial cells, alter membrane permeability, and cause proteinuria. None of the other options are responsible for this process.
Which statements are true concerning struvite stones? (Select all that apply.)a. They are more common in women than in men.b. Struvite stones are associated with chronic laxative use in women.c. They grow large and branch into a staghorn configuration in renal pelvis and calyces.d. Struvite stones are closely associated with urinary tract infections caused by urease-producing bacteria, such as Pseudomonas.e. They are more common in men than in women.
A, C, DWomen are at greater risk for developing struvite stones, but the risk is greater because women have an increased incidence of urinary tract infections not because of chronic laxative use. Such stones grow large and branch into a staghorn configuration and are associated with Pseudomonas.
Which statements are true regarding renal colic? (Select all that apply.)a. Renal colic results in mild-to-moderate pain.b. Pain originates in the flank area.c. Renal colic indicates the presence of renal stones.d. Pain radiated to the groin.e. Renal colic indicates obstruction of the renal pelvis or proximal ureter.
B, C, D, ERenal colic is described as moderate-to-severe pain often originating in the flank and radiating to the groin. It usually indicates obstruction by renal stones of the renal pelvis or proximal ureter.
Which conditions related to the bladder would result from the effects of lesions of the sacral segments below S1? (Select all that apply.)a. Frequencyb. Urge incontinencec. Bladder distensiond. Urgencye. Urinary retention
C, ELesions 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. The result is an acontractile detrusor or atonic bladder with retention of urine and distention. The other options are associated with neurologic lesions that occur between C2 and S1
What are considered risk factors for developing bladder and kidney cancers? (Select all that apply.)a. Cigarette smokingb. Hypertensionc. Exposure to aniline dyesd. Below normal body weighte. Male gender
A, B, CRisk factors for renal cancer include cigarette smoking, obesity, and hypertension. The risk of primary bladder cancer is greater among people who smoke or those who are exposed to metabolites of aniline dyes or other aromatic amines or chemicals and with heavy consumption of phenacetin. Gender is not a recognized risk factor.
Which renal disorders are considered causes of intrarenal renal failure? (Select all that apply.)a. Acute glomerulonephritisb. Allograft rejectionc. Tumorsd. Acute tubular necrosis (ATN)e. Prostatic hypertrophy
A, B, C, DIntrarenal (intrinsic) acute kidney injury (AKI) may result from ischemic ATN, nephrotoxic ATN, acute glomerulonephritis, vascular disease, allograft rejection, or interstitial disease (drug allergy, infection, tumor growth). Prostatic hypertrophy is not associated with intrarenal renal failure.
Prerenal injury from poor perfusion can result from which condition? (Select all that apply.)a. Bilateral ureteral obstructionb. Renal vasoconstrictionc. Renal artery thrombosisd. Hemorrhagee. Hypotension
B, C, D, EPoor perfusion can result from renal artery thrombosis, hypotension related to hypovolemia (dehydration, diarrhea, fluid shifts) or hemorrhage, renal vasoconstriction and alterations in renal regional blood flow, microthrombi, or kidney edema that restricts arterial blood flow. Bilateral ureteral obstruction is not associated with prerenal injuries.
Match the predisposing factors causing pyelonephritis to the pathology mechanism.______ A. Kidney stones______ B. Vesicoureteral reflux______ C. Pregnancy______ D. Neurogenic bladder______ E. Female sexual traumaMovement of organisms from the urethra into the bladder with infection and retrograde spread to the kidney
ANS: E PTS: 1 REF: Page 1352 | Table 38-4MSC: Female sexual trauma can result from the movement of organisms from the urethra into the bladder with infection and retrograde spread to the kidney.
Match the predisposing factors causing pyelonephritis to the pathology mechanism.______ A. Kidney stones______ B. Vesicoureteral reflux______ C. Pregnancy______ D. Neurogenic bladder______ E. Female sexual traumaDilation and relaxation of the ureter with hydroureter and hydronephrosis
ANS: C PTS: 1 REF: Page 1352 | Table 38-4MSC: Pregnancy causes the dilation and relaxation of the ureter with hydroureter and hydronephrosis.
Match the predisposing factors causing pyelonephritis to the pathology mechanism.______ A. Kidney stones______ B. Vesicoureteral reflux______ C. Pregnancy______ D. Neurogenic bladder______ E. Female sexual traumaImpairment to the bladder, interfering with normal bladder contraction and causing residual urine and ascending infection
ANS: D PTS: 1 REF: Page 1352 | Table 38-4MSC: Neurogenic bladder, caused by neurologic impairment, results in the interference of normal bladder and urethral sphincter contraction and causes residual urine and ascending infection.
Match the predisposing factors causing pyelonephritis to the pathology mechanism.______ A. Kidney stones______ B. Vesicoureteral reflux______ C. Pregnancy______ D. Neurogenic bladder______ E. Female sexual traumaObstruction and stasis of urine, contributing to bacteremia and hydronephrosis; irritation of epithelial lining with entrapment of bacteria
ANS: A PTS: 1 REF: Page 1352 | Table 38-4MSC: Kidney stones result in the obstruction and stasis of urine, contributing to bacteriuria and hydronephrosis and causing irritation of epithelial lining with entrapment of bacteria.
Match the predisposing factors causing pyelonephritis to the pathology mechanism.______ A. Kidney stones______ B. Vesicoureteral reflux______ C. Pregnancy______ D. Neurogenic bladder______ E. Female sexual traumaChronic reflux of urine up the ureter and into the kidney during micturition, contributing to bacterial infection
ANS: B PTS: 1 REF: Page 1352 | Table 38-4 MSC: Vesicoureteral reflux results in the chronic reflux of urine up the ureter and into the kidney during micturition, contributing to bacterial infection. |
Considering host defense mechanisms, which element in the urine is bacteriostatic, if any?
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