NR507 / NR 507 Final Exam Study Guide (Latest 2024 / 2025): Advanced Pathophysiology – Chamberlain
NR-507 Advanced Pathophysiology
Final Exam Study Guide
Renal System
- What are the two main functions of the kidney
Review diagram for anatomical structures
Correct Answer: - Filtration and collection
Urinary Tract pre-quiz Q’s
Women are at a higher risk for the development of a UTI because of having
a shorter urethra.
a. True
b. False
Correct Answer:
True
Which of the following can help to prevent a UTI?
a. Increase water consumption
b. Use spermicides during sexual intercourse
c. Taking more Vitamin D
d. Douching to prevent the growth of bacteria
Correct Answer:
Increase water consumption
A symptom of a lower urinary tract infection includes:
a. Flank pain
b. Urgency
c. Decreased Urination
d. Fever
Correct Answer:
Urgency
Which of the following is true regarding a complicated urinary tract infection?
a. It is usually asymptomatic
b. Can be caused by a structural urinary tract disorder
c. Bacteria is located mostly in the lower urinary tract
d. Is associated with young adults
Correct Answer:
Can be caused by a structural urinary tract disorder
Which of the following is a risk factor for the development of a urinary tract
infection (UTI)?
a. Perimenopause
b. Frequent showering
c. Marathon running
d. Pregnancy
Correct Answer:
Pregnancy
- Where do bacteria commonly come from in UTI’s
- Where can a UTI occur?
- It is more common for women to develop a UTI especially when
Correct Answer: - Bacteria from the gut can invade the urinary epithelium to cause
inflammation and infection - anywhere along the urinary tract such as the urethra, bladder, ureter, or
kidney - pregnant,
sexually active,
during post-menopause with estrogen-deficiency and
when being treated with antibiotics where the normal bacteria flora is
diminished - Escherichia coli can bind to cells in the lower urinary tract and hide from
the immune cells. The bacteria can form biofilms-what is this? - Describe the pathophysiology of a UTI that can lead to septic shock or
bacterimia
Note the diagram btw a male & female urinary tract (who’s is much shorter)
Correct Answer: - A biofilm is any group of microorganisms that allow them to stick to one
another and adhere to surfaces that help them survive. - First, bacteria enter and contaminate the lower urinary tract. This causes
the colonization of bacteria in the urethra and the bladder. If the UTI
progresses the bacteria can ascend to the kidneys and colonize there. At this
point, the infection becomes an upper UTI. From there, if left untreated, the
bacteria can spread into the circulation via the renal veins causing
bacteremia
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Women are at a higher risk for the development of a UTI because of having a shorter urethra. True or False
True
Which of the following can help to prevent a UTI?
A. Douching to prevent the growth of bacteria
B. Increase water consumption
C. Taking more Vitamin D
D. Use spermicides during sexual intercourse
Increase water consumption
Which of the following is a risk factor for the development of a urinary tract infection (UTI)?
A. Frequent showering
B. Perimenopause
C. Marathon running
D. Pregnancy
D. Pregnancy
A symptom of a lower urinary tract infection includes:
A. Decreased Urination
B. Fever
C. Flank pain
D. Urgency
D. Urgency
Which of the following is true regarding a complicated urinary tract infection?
A. Bacteria is located mostly in the lower urinary tract
B. Is associated with young adults
C. Can be caused by a structural urinary tract disorder
D. It is usually asymptomatic
C. Can be caused by a structural urinary tract disorder
Uncomplicated UTI:
A. Occurs in the normal urinary tract
B. A UTI that extends beyond the bladder
C. Caused by structural or functional urinary tract abnormalities or untreated UTI
D. Responds well to a short course of antibiotic therapy
E. Infants and older adults affected
F. Simple cystitis in non-pregnant women without any urologic abnormalities
G. Associated with: indwelling catheters, renal calculi, diabetes, pregnancy
A. Occurs in the normal urinary tract
D. Responds well to a short course of antibiotic therapy
F. Simple cystitis in non-pregnant women without any urologic abnormalities
Complicated UTI:
A. Occurs in the normal urinary tract
B. A UTI that extends beyond the bladder
C. Caused by structural or functional urinary tract abnormalities or untreated UTI
D. Responds well to a short course of antibiotic therapy
E. Infants and older adults affected
F. Simple cystitis in non-pregnant women without any urologic abnormalities
G. Associated with: indwelling catheters, renal calculi, diabetes, pregnancy
B. A UTI that extends beyond the bladder
C. Caused by structural or functional urinary tract abnormalities or untreated UTI
E. Infants and older adults affected
G. Associated with: indwelling catheters, renal calculi, diabetes, pregnancy
A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner.
The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with:
A. Cystitis
b. Complicated UTI
C. Pyelonephritis
D. Upper UTI
A. Cystitis
J.S. is an 80 -year-old patient who resides in a local nursing home. He recently became confused and then fell while ambulating to the bathroom three days ago. Because of his confusion and fall, he was transferred to the acute care facility for evaluation and treatment. Lab work revealed that the patient was very dehydrated with hypernatremia identified and appropriate intravenous fluids started. Cystitis was also identified from the urinalysis. He was also noted to have red and excoriated skin between the buttocks and inner thighs due to urinary frequency and dribbling. To help with skin healing and to prevent further urine leakage, an indwelling catheter was inserted. Two days after the catheter was placed, the patient spiked a fever of 102 degrees Fahrenheit associated with shaking chills. An intense, foul odor was noted in the urine. On examination of the flank area, the patient yelled out when touched. A urine culture was obtained and came back positive for nitrites and RBCs. Urine microscopy revealed >100,000 WBC/hpf and casts.
Based on the information provided in the case, the patient can most likely be diagnosed with:
A. Urinary obstruction
B. Pyelonephritis
C. Simple UTI
D. Glom
B. Pyelonephritis
Identify the major risk factor J.S. has that is associated with pyelonephritis:
Indwelling Foley catheter
Flank pain
Dehydration
Fever
Indwelling Foley catheter
The urinalysis of a patient with a complicated UTI will show WBCs and casts
True
False
True
A common organism that causes a urinary tract infection include:
Syncytial virus.
Staphylococcus saprophyticus.
Methicillin Resistant Staphylococcus Aureus (MRSA).
Streptococcus pneumonia.
Staphylococcus saprophyticus.
Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are gram negative because of the presence of:
RBCs.
Casts.
Nitrites.
WBCs.
Nitrites
The NP would know that the patient most likely has an uncomplicated UTI because:
The UTI responds well to a short course of antibiotic therapy.
The bacteria are contained within the bladder.
There is low-grade fever.
Flank pain is present but minimal.
The UTI responds well to a short course of antibiotic therapy.
A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit.
True
False
True
The purpose of straining in BPH is to overcome the obstruction encountered during urination.
True
False
True
On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings?
A lack of pain on palpation.
A hard nodule.
A soft-smooth prostate.
A rubber-like quality of the prostate.
A hard nodule
The peripheral zone of the prostate is the largest zone.
True
False
true
The patient most often develops symptoms of BPH when:
The bladder becomes obstructed.
The prostatic urethra becomes obstructed.
The patient’s PSA becomes elevated.
A nodule forms on the prostate.
The prostatic urethra becomes obstructed.
There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer.
True
False
False
Obstructive symptoms of BPH
nocturia
urinary frequency
urgency that result from bladder hypertrophy and dysfunction
postvoid dribbling
incomplete emptying
postvoid dribbling
incomplete emptying
Irritative symptoms of BPH
nocturia
urinary frequency
urgency that result from bladder hypertrophy and dysfunction
postvoid dribbling
incomplete emptying
nocturia
urinary frequency
urgency that result from bladder hypertrophy and dysfunction
The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply.
True
False
True
The action of a 5-Alpha-reductase inhibitor causes:
Shrinkage of the prostate gland.
Reduction of the size of the nodule that is causing obstruction.
Relaxation of the smooth muscle of the bladder neck.
Relaxation of the external sphincter.
Shrinkage of the prostate gland.
Men who have BPH are prone to developing a UTI because:
The prostate is not a sterile environment.
Stagnated urine in the bladder promotes bacterial growth.
Ingested fluids do not adequately flush the kidneys.
They have a low WBC count due to an infected prostate.
Stagnated urine in the bladder promotes bacterial growth.
The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation.
True
False
True
The location of the characteristic hyperplastic nodules of BPH is:
In the zone immediately inside the rectum.
In the posterior prostate.
In the anterior prostate zone.
In the periurethral zone.
In the periurethral zone.
Renal calculi are typically confined to the bladder.
True
False
False
The most common type of stone is:
Uric acid stone.
Struvite stone.
Cysteine stone.
Calcium stone.
Calcium
The gold standard for diagnosing a renal stone is a urinalysis.
True
False
False
Renal stones are formed when calcium and oxalate in the urine combine.
True
False
True
The type of stone that forms due to a urinary tract infection is:
Uric acid stone.
Struvite stone.
Cysteine stone.
Calcium Stone.
Struvite stone.
This is the most common type of stone. It forms from the joining of calcium and oxalate or from the joining of calcium and phosphate. In some cases, individuals can form both types of calcium stone. Calcium stones are radio dense which indicates that they can be seen on x-ray. The cause of calcium stones is mostly idiopathic or unknown. Regardless of the cause, the individual becomes either hypercalcemic or presents with excess calcium in the urine (hypercalciuria). This causes the solutes to increase and form a stone. Treatment involves prescribing a thiazide diuretic to excrete urinary calcium.
Calcium stone
This type of stone occurs due to a urinary tract infection, most often by proteus, klebsiella and serratia and enterobacter species. Ammonium, magnesium, and phosphate form to create the stone. The bacteria contribute to the stone formation through the production of the enzyme, urease. Urea, in the presence of urease converts to ammonia and a byproduct of CO2. This makes the urine alkaline which favors stone formation. Another name for this stone is the Staghorn stone. It obstructs the renal calyx. The location of the Staghorn stone is shown in the diagram below. The stone is given its name because of it contains irregular, horn-like structures.
Struvite stone
This is the type of stone that is found in a patient with gout. There is an increase in uric acid. Individuals who are at risk for getting gout include those with leukemia and myeloproliferative disorder; those undergoing chemotherapy. Chemotherapy destroys the cancer cells. DNA cells contain purine. When broken down, purine will increase uric acid levels that can lead to uric acid stone formation. Uric acid increases the acidity of the urine with resultant decrease in urine pH. Uric acid stones are radiolucent, meaning that the stones cannot be seen on x-ray. Treatment includes hydration and increasing the alkaline of the urine by giving potassium bicarbonate. Individuals will also be prescribed allopurinol, an anti-gout medication.
Uric acid stone
This is a rare type of kidney stone that is found mostly in children. It is caused by a genetic renal tubule defect that prevents the amino acid, cystine, from being reabsorbed that leads to the formation of a cystine stone. This stone can also from Staghorn shaped stones.
Cystine stone
A 45-year-old male presents to the primary care office with right flank pain that he describes as unremitting; he also reports nausea and vomiting. The NP performs an exam and observes him writhing in pain on the exam table with the inability to find a comfortable position. He is afebrile, BP 156/88 mmHg and HR 106/min. Right flank is mildly tender on palpation. Abdominal exam is negative for any abnormality. A urinalysis was performed and revealed 1+ blood. Urine microscopy also revealed 10-20 RBCs per high-power field (hpf). A kidney stone is suspected. The patient reports no prior history of a kidney stone. After providing the patient an analgesic, where the patient reported mild relief, the NP had the patient transferred to the emergency room for intravenous fluids, pain management and further work-up for the kidney stone. Upon follow-up in the office a week later, the patient reported that he was diagnosed with a kidney stone, but he was not aware of the type of stone or the cause for it. He was very concerned about why he had the associated severe flank pain and asked the NP why the pain was so severe and how could he avoid another stone in the future.
Since this is the patient’s f
Adequate hydration
A balanced diet
Lithotripsy is an invasive procedure used to break up the stone
True
False
False
Hematuria can be seen with kidney stones because:
The stone creates its own blood supply around it.
The stone injures the urinary structures as it passes through them.
As WBCs increase, the RBCs also increase.
The patient becomes anemic when stones form.
The stone injures the urinary structures as it passes through them.
The most common stone found in the patient with gout is:
Uric acid stone.
Struvite stone.
Calcium stone.
Cystine stone.
Uric acid stone.
Renal colic is caused by the passing of the stone through the ureter.
True
False
True
At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone.
True
False
True
The location of the internal sphincter is under the urogenital diaphragm.
True
False
False
Which of the following actions will relax the detrusor muscle of the bladder?
Activation of the muscarinic (M3) receptors by the sympathetic nervous system.
Activation of Beta-2 receptors by the sympathetic nervous system.
Activation of the muscarinic (M3) receptors by the parasympathetic nervous system.
Inhibition of the Beta-2 receptors by the sympathetic nervous system.
Activation of Beta-2 receptors by the sympathetic nervous system.
The levator ani muscle plays a major role in constriction of the external sphincter.
True
False
True
When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict.
True
False
True
The relay station in the brain that plays a major role in regulating micturition is:
The cerebellum.
The frontal lobe.
Pontine micturition center.
Hypothalamic relay center.
Pontine micturition center.
Leakage of urine with activity Increased intraabdominal pressure causes leaking because there is no resistance to counteract the intraabdominal pressure
Stress Incontinence
Urge Incontinence
Leakage of urine with sensation of need to urinate Detrusor muscle hyperactivity leads to urine leakage
Urge Incontinence
Unimpeded urine leakage Neurological lesions alter nervous system impulses that innervate the detrusor muscle. The result is decreased bladder compliance and decreased sphincter tone
Neurogenic Incontinence
Leakage of urine is associated with urgency, frequency, dribbling and hesitancy Leakage is due to retained urine in the bladder that leads to overdistention
Overflow Incontinence
The major cause of stress incontinence in women is hypermobility of the external sphincter.
True
False
True
Which of the following is considered be a transient cause of urinary incontinence?
Epithelial damage to the bladder wall.
Structural malformation of the external sphincter.
Chronic renal failure.
Urinary tract infection.
Urinary tract infection
Involuntary loss of urine caused by dementia or immobility is known as:
Functional incontinence.
Stress incontinence.
Neurogenic incontinence.
Urge incontinence.
Functional incontinence.
A sphincter malfunction that prevents urine from flowing out of the bladder would most likely result in:
Urge incontinence.
Overflow incontinence
Stress incontinence.
Functional incontinence.
Overflow incontinence
The pathophysiology of neurogenic bladder is:
Increased intraabdominal pressure causes leaking.
Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone.
Detrusor muscle hyperactivity leads to urine leakage.
Leakage is due to retained urine in the bladder that leads to overdistention.
Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone.
One of the first pathophysiological responses to the decreased GFR in acute renal failure is:
Reabsorption of BUN.
Activation of the renin-angiotensin-aldosterone system.
Secretion of creatine.
Increased urination.
Activation of the renin-angiotensin-aldosterone system.
One of the major markers for glomerular filtration rate is creatinine.
True
False
Te
Pre-renal is the most common cause of acute renal failure.
True
False
true
The most common cause of acute renal failure is due to a pre-renal failure.
True
False
True
A pre-renal cause of acute renal failure is:
Inflammation to the renal tubules.
Hypotension
Obstruction.
Drug toxicity.
Hypotension
One of the issues that requires management of a patient with acute renal failure is hypokalemia
True
False
True
Which of the following is true regarding creatinine?
A lower creatinine points to decreased GFR.
Will be decreased during renal failure.
Creatinine gets freely filtered from the glomerulus.
Is mostly reabsorbed by the distal tubule.
Creatinine gets freely filtered from the glomerulus.
In post-renal failure, the damage occurs in the collecting duct.
True
False
True
Which of the following is the best indicator of a good prognosis for recovery from acute renal failure?
BUN and Creatinine return to normal.
The potassium level returns to normal.
Dialysis is not needed.
The kidney responds to furosemide
The kidney responds to furosemide
In intrinsic renal failure, sodium and water excretion is increased which leads to a dilute urine.
True
False
True
The result of vitamin D deficiency results in:
Hypercalcemia.
Hypomagnesemia.
Hypophosphatemia.
Hypocalcemia.
Hypocalcemia.
Which of the following is a complication of decreased GFR?
Hypotension.
Hypercalcemia.
Uremic skin.
Anemia.
Anemia.
Stage III kidney disease is signified when the GFR drops below 60.
True
False
True
The anemia seen in renal failure is due to the lack or iron.
True
False
False
The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined.
True
False
True
Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function.
True
False
False
Dietary management of a patient with CKD includes:
High potassium, low sodium, and low phosphate diet.
Low potassium, low sodium, and low phosphate diet.
Low potassium, low sodium, and high phosphate diet.
Low potassium, high sodium, and low phosphate diet.
Low potassium, low sodium, and low phosphate diet.
The major acid/base disturbance in renal failure is:
Metabolic alkalosis.
Respiratory acidosis.
Metabolic acidosis.
Respiratory alkalosis.
Metabolic acidosis.
End-stage renal disease is signified by a GFR of:
<30.
<20.
<25.
<15.
<15.
The decision to begin dialysis is guided by the patient’s symptoms rather than GFR.
True
False
True