Question 1

A patient who has a history of mildly decreased renal function is admitted to the hospital for IV antibiotics. Which antibiotics would the healthcare professional avoid in this patient?

Accepted Answer

Although numerous antibiotics can produce nephrotoxic ATN, the aminoglycosides (gentamicin, tobramycin) are the major culprits. The healthcare professional would avoid their use in this patient if at all possible.

Question 2

Bladder cancer is associated with the gene mutation of which gene?

Accepted Answer

Oncogenes 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. The c-erbB2 gene is associated with breast cancer as is HER2. The myc gene codes for a transcription factor that plays a role in cellular life cycle events.

Question 3

Hypothyroidism, edema, hyperlipidemia, and lipiduria characterize which kidney disorder?

Accepted Answer

Symptoms of nephrotic syndrome include edema, hyperlipidemia, lipiduria, vitamin D deficiency, and hypothyroidism.

Question 4

A female patient has been diagnosed with an uncomplicated urinary tract infection. What self-care measure does the healthcare provider teach the patient that is specific to this type of infection?

Accepted Answer

The most common infecting microorganisms are E. coli (80% to 85%) which is transmitted from the gut where it is a normal resident. Women should be taught to wipe from front to back after using the bathroom to avoid contamination of the urinary meatus with fecal material containing E. coli. The other options are appropriate for any type of infection.

Question 5

How are glucose and insulin used to treat hyperkalemia associated with acute renal failure?

Accepted Answer

In severe hyperkalemia, potassium can be driven temporarily back into the cell with insulin. Glucose will also move into the cell. The glucose metabolism helps drive the potassium movement. Glucose is also given to prevent the patient from developing hypoglycemia.

Question 6

An 85-year-old person has a urinary tract infection. What clinical manifestation does the healthcare professional expect to see in this person?

Accepted Answer

Older adults with cystitis may demonstrate confusion or vague abdominal discomfort or otherwise be asymptomatic.

Question 7

A patient has been diagnosed with a renal stone. Based on knowledge of common stone types, what self-care measure does the healthcare professional plan to teach the patient when stone analysis has returned?

Accepted Answer

Calcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all stones requiring treatment. While all choices are appropriate for self-care in the patient with kidney stones, maintaining a calcium intake of 1000 to 1200 mg/day is a specific preventative measure for calcium stones.

Question 8

Detrusor hyperreflexia develops from neurologic disorders that originate where?

Accepted Answer

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

Question 9

Goodpasture syndrome is an example of which of these?

Accepted Answer

Antiglomerular 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.

Question 10

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. What diagnostic test or treatment regime does the healthcare professional educate the patient on?

Accepted Answer

The data suggest the patient has 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. There are several types of this disorder and treatment is specific to individual types. The patient needs a renal biopsy to determine appropriate treatment. A pyelogram would help identify kidney stones. Oral antibiotics would be used if there is an infection. Cyclophosphamide can be used in glomerulonephritis that is unresponsive to corticosteroids.

Question 11

Which glomerular lesion is characterized by thickening of the glomerular capillary wall with immune deposition of immunoglobulin G (IgG) and C3?

Accepted Answer

The thickening of the glomerular capillary wall characterizes only membranous lesions.

Question 12

The student asks the professor to explain the role of pyrophosphate, potassium citrate, and magnesium in the formation of kidney stones. What response by the professor is best?

Accepted Answer

Stone or crystal growth inhibiting substances, including potassium citrate, pyrophosphate, and magnesium, are capable of crystal growth inhibition. They do not stimulate supersaturation of salt, facilitate the precipitation of salts, or enhance crystallization of salts.

Question 13

Which abnormal laboratory value is found in glomerular disorders?

Accepted Answer

Elevated 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. Many factors can lead to an elevation in BUN such as dehydration or poor perfusion, in addition to kidney disease. Elevated IgA levels are associated with Berger disease. Low serum complement levels would affect immune functioning.

Question 14

A healthcare professional is assessing a patient who could have either pyelonephritis or cystitis. Which differentiating sign would assist the professional in making this diagnosis?

Accepted Answer

Clinical 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. When present, white blood cell casts indicate pyelonephritis. Difficulty starting the urine stream could indicate prostate enlargement. Neither disorder has spasmodic pain that radiates to the groin; this would be indicative of a kidney stone. Increased GFR would not be seen in an infectious disorder.

Question 15

Pyelonephritis is usually caused by which type of organism?

Accepted Answer

Pyelonephritis is usually caused by the bacteria Escherichia coli, Proteus, or Pseudomonas.

Question 16

Hypercalciuria is primarily attributable to which alteration?

Accepted Answer

Hypercalciuria 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.

Question 17

Creatinine is primarily excreted by glomerular filtration after being constantly released from what type of tissue?

Accepted Answer

Creatinine is constantly released from muscle tissue to be excreted by glomerular filtration.

Question 18

A patient has overactive bladder syndrome. Which classification of drug does the healthcare professional plan to teach the patient about?

Accepted Answer

Because the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by a-adrenergic blocking (antimuscarinic) medications. The other medications would not be of benefit in this situation.

Question 19

How does progressive nephron injury affect angiotensin II activity?

Accepted Answer

Angiotensin II activity is elevated with progressive nephron injury. Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension. The chronically high intraglomerular pressure increases glomerular capillary permeability, contributing to proteinuria. Angiotensin II also may promote the activity of inflammatory cells and growth factors that participate in tubulointerstitial fibrosis and scarring.

Question 20

Which urine characteristics are indicative of acute tubular necrosis (ATN) caused by intrinsic (intrarenal) failure?

Accepted Answer

Urine sodium >30 mEq/L is the only option indicative of ATN. The other findings are associated with prerenal kidney injury.

Quiz 39: Alterations of Renal and Urinary Tract Function