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Paramedic Midterm > Chapter 22 Genitourinary and Renal Emergencies > Flashcards

Chapter 22 Genitourinary and Renal Emergencies Flashcards

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1
Q
  1. Which of the following statements regarding the renal system is correct?
    A) Urinary tract infections are more prevalent in men.
    B) The kidneys are located in the retroperitoneal space.
    C) Urinary tract infections are the most common renal disease.
    D) The urethra transports urine from the kidneys to the bladder.
A

Ans: B
Page: 1161
Type: General Knowledge

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2
Q 
2.  The renal \_\_\_\_\_\_\_ is the middle layer of the kidney and includes the renal pyramids.
A)  cortex
B)  medulla
C)  calyces
D)  capsule
A

Ans: B
Page: 1162
Type: General Knowledge

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3
Q 
3.  The main filter for blood in the kidney is the:
A)  hilus.
B)  calyces.
C)  renal pyramid.
D)  glomerulus.
A

Ans: D
Page: 1162
Type: General Knowledge

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4
Q 
4.  The structural and functional unit of the kidney is the:
A)  nephron.
B)  medulla.
C)  renal cortex.
D)  podocyte.
A

Ans: A
Page: 1162
Type: General Knowledge

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5
Q
  1. The glomerular filtration rate is defined as the:
    A) percentage of filtrate that remains in the kidneys.
    B) amount of filtrate produced by the kidneys per minute.
    C) volume of blood that flows through the kidneys per minute.
    D) pressure in the glomerulus that forces filtrate from the blood.
A

Ans: B
Page: 1163
Type: General Knowledge

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6
Q 
6.  As the filtrate passes through the rest of the nephron, tubular reabsorption and tubular secretion convert it to:
A)  salt.
B)  water.
C)  urine.
D)  glucose.
A

Ans: C
Page: 1163
Type: General Knowledge

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7
Q 
7.  After the cells lining the proximal convoluted tubule remove all organic nutrients, plasma proteins, and ions from the filtrate, additional reabsorption of water and electrolytes occurs in the:
A)  glomerulus.
B)  macula densa.
C)  loop of Henle.
D)  distal convoluted tubule.
A

Ans: C
Page: 1163
Type: General Knowledge

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8
Q 
8.  When triggered by changes in the blood pressure, the juxtaglomerular cells release:
A)  renin.
B)  aldosterone.
C)  angiotensin I.
D)  angiotensinogen.
A

Ans: A
Page: 1163
Type: General Knowledge

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9
Q 
9.  Angiotensin II:
A)  relaxes smooth muscle.
B)  decreases sodium reabsorption.
C)  decreases blood pressure.
D)  is a potent vasoconstrictor.
A

Ans: D
Page: 1163
Type: General Knowledge

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10
Q
  1. When the solute concentration of the blood increases:
    A) water is excreted from the body by the kidneys.
    B) antidiuretic hormone is released into the bloodstream.
    C) the release of angiotensin II causes the blood pressure to fall.
    D) the distal convoluted tubule becomes less permeable to water.
A

Ans: B
Page: 1164
Type: General Knowledge

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11
Q
  1. Aldosterone produces all of the following physiologic effects, EXCEPT:
    A) increased water reabsorption by the kidneys.
    B) retention of potassium ions in the body.
    C) increased sodium and chloride reabsorption.
    D) decreased reabsorption of potassium ions.
A

Ans: B
Page: 1164
Type: General Knowledge

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12
Q
  1. Furosemide (Lasix) causes diuresis by:
    A) increasing circulating blood glucose.
    B) converting angiotensin I to angiotensin II.
    C) inhibiting sodium reabsorption in the kidneys.
    D) inhibiting the production of antidiuretic hormone.
A

Ans: C
Page: 1164
Type: General Knowledge

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13
Q
  1. Diuril would MOST likely be prescribed to a patient with:
    A) congestive heart failure.
    B) persistent hypokalemia.
    C) a decreased cardiac output.
    D) vasoconstriction-induced hypertension.
A

Ans: A
Page: 1164
Type: General Knowledge

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14
Q
  1. The micturition reflex:
    A) produces the urge to void.
    B) collapses the walls of the bladder.
    C) is regulated by one of the cranial nerves.
    D) causes relaxation of the urinary sphincter.
A

Ans: A
Page: 1164
Type: General Knowledge

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15
Q 
15.  In contrast to the male urethra, the female urethra:
A)  is approximately 20 cm long.
B)  is divided into three regions.
C)  consists of a prostatic urethra.
D)  is significantly shorter in length.
A

Ans: D
Page: 1164
Type: General Knowledge

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16
Q
  1. Most urinary tract infections:
    A) are asymptomatic and are diagnosed when a urinalysis is performed during a routine physical exam.
    B) occur in women due to the relatively short urethra and its close proximity to the vagina and rectum.
    C) involve the lower urinary tract in males because the urethra’s large surface area can house more bacteria.
    D) are the result of viruses or fungi entering the external urethral opening secondary to poor personal hygiene.
A

Ans: B
Page: 1169
Type: General Knowledge

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17
Q
  1. Which of the following statements regarding pyelonephritis is correct?
    A) Untreated pyelonephritis typically heals spontaneously.
    B) Most cases of pyelonephritis occur in the lower urinary tract.
    C) Pyelonephritis is an inflammation of the linings of the kidney.
    D) In pyelonephritis, the ureters become inflamed and infected.
A

Ans: C
Page: 1169
Type: General Knowledge

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18
Q 
18.  Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT:
A)  gross hematuria.
B)  painful urination.
C)  increased urinary frequency.
D)  localized pain in the pelvis.
A

Ans: A
Page: 1169
Type: General Knowledge

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19
Q
  1. The pain associated with a kidney stone MOST often:
    A) is described by the patient as a dull ache.
    B) begins as a sharp pain in the right upper quadrant.
    C) radiates from the umbilicus to the pubic symphysis.
    D) begins in the flank region and radiates to the groin.
A

Ans: D
Page: 1170
Type: General Knowledge

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20
Q 
20.  A renal calculus that has become lodged in a lower ureter would likely produce all of the following signs and symptoms, EXCEPT:
A)  fever.
B)  hematuria.
C)  urinary urgency.
D)  painful urination.
A

Ans: A
Page: 1170
Type: General Knowledge

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21
Q 
21.  The MOST important therapy the paramedic can administer to a patient with an isolated renal calculus is:
A)  oxygen.
B)  rehydration.
C)  analgesia.
D)  an antiemetic.
A

Ans: C
Page: 1170
Type: General Knowledge

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22
Q 
22.  A marked decrease in urine output is called:
A)  anuria.
B)  oliguria.
C)  dysuria.
D)  polyuria.
A

Ans: B
Page: 1170
Type: General Knowledge

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23
Q 
23.  A patient with prerenal acute renal failure would MOST likely present with:
A)  confusion and hypertension.
B)  joint pain and bladder distention.
C)  hypotension and tachycardia.
D)  peripheral edema and hematuria.
A

Ans: C
Page: 1170-1171
Type: General Knowledge

24
Q 
24.  A common cause of intrarenal acute renal failure is:
A)  hypovolemia.
B)  type 1 diabetes.
C)  a renal calculus.
D)  myocardial infarction.
A

Ans: B
Page: 1171
Type: General Knowledge

25
Q
  1. Which of the following statements regarding postrenal acute renal failure (ARF) is correct?
    A) Patients with postrenal ARF typically develop severe hypokalemia.
    B) Postrenal ARF involves damage to the renal parenchyma or tubules.
    C) Postrenal ARF typically results in decreased pressure on the nephrons.
    D) Postrenal ARF is caused by obstruction of urine flow from the kidneys.
A

Ans: D
Page: 1171
Type: General Knowledge

26
Q
  1. Acute renal failure is MOST accurately defined as:
    A) a sudden decrease in filtration through the glomeruli.
    B) irreversible damage to the nephrons and renal tubules.
    C) an acute drop in urine output to less than 750 mL/day.
    D) sudden damage to the renal parenchyma due to sepsis.
A

Ans: A
Page: 1170
Type: General Knowledge

27
Q
  1. Most cases of chronic renal failure are caused by:
    A) systemic diseases such as diabetes.
    B) nephron deterioration due to aging.
    C) frequent lower urinary tract infections.
    D) nephron destruction due to medications.
A

Ans: A
Page: 1172
Type: General Knowledge

28
Q
  1. Azotemia is defined as:
    A) electrolyte disturbances in the blood.
    B) an accumulation of uric acid in the blood.
    C) increased nitrogenous wastes in the blood.
    D) excess potassium excretion by the kidneys.
A

Ans: C
Page: 1172
Type: General Knowledge

29
Q 
29.  The skin of a patient with chronic renal failure is MOST often:
A)  flushed.
B)  jaundiced.
C)  cyanotic.
D)  cool and dry.
A

Ans: B
Page: 1172
Type: General Knowledge

30
Q 
30.  Patients with chronic renal failure may present with uremic frost, especially:
A)  in the urine.
B)  during emesis.
C)  to the flank area.
D)  around the face.
A

Ans: D
Page: 1172-1173
Type: General Knowledge

31
Q 
31.  Clinical manifestations of chronic renal failure include all of the following, EXCEPT:
A)  dehydration.
B)  hyperkalemia.
C)  hypotension.
D)  QT prolongation.
A

Ans: A
Page: 1172
Type: General Knowledge

32
Q 
32.  Definitive treatment for a patient with end-stage renal disease involves:
A)  renal dialysis.
B)  diuretic therapy.
C)  crystalloid fluids.
D)  kidney transplant.
A

Ans: D
Page: 1173
Type: General Knowledge

33
Q 
33.  Initial signs or symptoms of end-stage renal disease include:
A)  bone pain.
B)  uremic frost.
C)  pruritus.
D)  hallucinations.
A

Ans: A
Page: 1173
Type: General Knowledge

34
Q 
34.  The skin of a patient with end-stage renal disease:
A)  is hot and dry.
B)  is thickened.
C)  may appear bruised.
D)  is usually flushed.
A

Ans: C
Page: 1173
Type: General Knowledge

35
Q
  1. End-stage renal disease occurs when:
    A) the initial signs of azotemia are present.
    B) the kidneys have lost all ability to function.
    C) urine output falls to less than 500 mL/day.
    D) the glomerular filtration rate is increased.
A

Ans: B
Page: 1173
Type: General Knowledge

36
Q
  1. Which of the following statements regarding peritoneal dialysis is correct?
    A) Because of the high risk of peritonitis, peritoneal dialysis can only be performed in a hospital or specialized dialysis center.
    B) In peritoneal dialysis, large amounts of specially formulated dialysis fluid are infused into the abdominal cavity and left for 1 to 2 hours.
    C) Peritoneal dialysis involves the surgical placement of an arteriovenous shunt in the vasculature of the abdominal cavity.
    D) Peritoneal dialysis is the least-preferred method of dialyzing a patient and is only used in extreme emergency situations.
A

Ans: B
Page: 1174
Type: General Knowledge

37
Q
  1. Unlike peritoneal dialysis, hemodialysis:
    A) is associated with a higher risk of peritonitis.
    B) filters nitrogenous waste products from the blood.
    C) involves the circulation of blood through a machine.
    D) is only used for patients experiencing acute renal failure.
A

Ans: C
Page: 1174
Type: General Knowledge

38
Q 
38.  A small, button-shaped device with a rubber septum that can be punctured with a dialysis needle is called a(n):
A)  HemaSite.
B)  Thomas shunt.
C)  Scribner shunt.
D)  internal shunt.
A

Ans: A
Page: 1174
Type: General Knowledge

39
Q 
39.  An arteriovenous fistula is usually located in the:
A)  peritoneal cavity.
B)  patient's groin area.
C)  distal lower extremity.
D)  forearm or upper arm.
A

Ans: D
Page: 1174
Type: General Knowledge

40
Q
  1. Patients requiring chronic dialysis:
    A) are typically not able to ambulate.
    B) are usually dialyzed every 2 or 3 days.
    C) are almost always inpatients in a hospital.
    D) stay on the dialysis machine for 6 to 8 hours.
A

Ans: B
Page: 1174
Type: General Knowledge

41
Q 
41.  Bradycardia and hypotension following an overaggressive dialysis treatment are MOST indicative of:
A)  hypovolemia.
B)  hypokalemia.
C)  hyperkalemia.
D)  air embolism.
A

Ans: B
Page: 1175
Type: General Knowledge

42
Q
  1. Disequilibrium syndrome is a condition in which:
    A) large amounts of water move by osmosis into the brain, resulting in an acute subdural hematoma.
    B) dialysis patients miss one or two of their treatments, resulting in hyperkalemia, azotemia, and hypotension.
    C) water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.
    D) the concentration of urea in the bloodstream is lowered slowly, while the solute concentration of the cerebrospinal fluid remains high.
A

Ans: C
Page: 1175
Type: General Knowledge

43
Q 
43.  All of the following conditions may cause urinary retention, EXCEPT:
A)  testicular torsion.
B)  nerve damage.
C)  urinary tract infections.
D)  benign prostatic hypertrophy.
A

Ans: A
Page: 1167
Type: General Knowledge

44
Q 
44.  Which of the following abdominal segments is anterior and is the most inferior?
A)  Umbilical region
B)  Iliac region
C)  Hypochondrial region
D)  Hypogastric region
A

Ans: D
Page: 1167
Type: General Knowledge

45
Q
  1. The MOST important aspect of assessing a patient with a genitourinary emergency is to:
    A) detect and treat life-threatening conditions.
    B) perform an immediate secondary assessment.
    C) rapidly determine the cause of the emergency.
    D) determine if the patient requires narcotic analgesia.
A

Ans: A
Page: 1165-1166
Type: General Knowledge

46
Q
  1. ECG monitoring of a patient with a suspected urologic emergency is especially important because of:
    A) myocardial ischemia that is often caused by urologic dysfunction.
    B) the medications that many patients with urologic problems are taking.
    C) the potential for electrolyte imbalances and their effect on the heart.
    D) frequent fluctuations in the patient’s heart rate caused by severe pain.
A

Ans: C
Page: 1166
Type: General Knowledge

47
Q 
47.  Which of the following is a potentially life-threatening complication of missing one or more dialysis treatments?
A)  Uremic frost
B)  Hyperkalemia
C)  Hypocalcemia
D)  Peripheral edema
A

Ans: B
Page: 1167, 1174
Type: General Knowledge

48
Q
  1. It is important for the paramedic to consult with medical control prior to administering analgesia to a patient with severe flank pain and suspected acute renal failure because:
    A) patients with renal failure often require high doses of analgesia.
    B) renal failure may cause analgesics to accumulate to toxic levels.
    C) most patients who are given analgesia will experience hypotension.
    D) analgesia will mask the patient’s pain and skew further examination.
A

Ans: B
Page: 1172
Type: General Knowledge

49
Q 
49.  A young woman presents with left-sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. You should suspect:
A)  renal failure.
B)  a renal calculus.
C)  kidney stones.
D)  pyelonephritis.
A

Ans: D
Page: 1169
Type: Critical Thinking

50
Q 
50.  You are dispatched to a residence for an elderly man with an altered mental status. As you are assessing the patient, his wife tells you that he goes to dialysis several times a week, but has missed his last three treatments because their car broke down. The patient's skin is yellow, his blood pressure is 98/60 mm Hg, and his pulse rate is 118 beats/min. The ECG reveals sinus tachycardia with peaked T waves. You should be MOST concerned with the potential for:
A)  severe hypovolemia.
B)  acute bradycardia or heart block.
C)  lethal ventricular dysrhythmias.
D)  hypokalemia-induced cardiac arrest.
A

Ans: C
Page: 1173-1176
Type: Critical Thinking

51
Q 
51.  A 59-year-old woman with chronic renal failure presents with an acute onset of dyspnea while undergoing a hemodialysis treatment. She is conscious but in obvious respiratory distress. Further assessment reveals perioral cyanosis and a blood pressure of 96/56 mm Hg. Based on this patient's medical history and clinical presentation, which of the following interventions is likely NOT indicated?
A)  IV crystalloid fluid boluses
B)  Left lateral recumbent position
C)  Rapid transport to the hospital
D)  Ventilation assistance as needed
A

Ans: A
Page: 1176
Type: Critical Thinking

52
Q 
52.  A 20-year-old male presents with an acute onset of severe testicular pain. He denies any trauma to the genital region. He is conscious and alert, his blood pressure is 144/84 mm Hg, his heart rate is 120 beats/min, and his respirations are 24 breaths/min with adequate depth. The MOST important aspect in the care of this patient involves:
A)  prompt transport.
B)  narcotic analgesia.
C)  IV fluid therapy.
D)  high-flow oxygen.
A

Ans: A
Page: 1177
Type: Critical Thinking

53
Q
  1. You receive a call to a residence for a 60-year-old man who is bleeding from his dialysis shunt. When you arrive, the patient’s wife, who has been properly trained on the use of the dialysis machine, tells you that she panicked and called EMS. The dialysis cannula has loosened from the needle, which is still in the shunt. Your initial action should be to:
    A) immediately clamp off the cannula and apply direct pressure.
    B) attempt to tighten the connection between the needle and cannula.
    C) remove the dialysis needle from the shunt and apply direct pressure.
    D) apply direct pressure over the shunt and carefully remove the needle.
A

Ans: B
Page: 1175-1176
Type: Critical Thinking

54
Q
  1. Immediately following a dialysis treatment, a middle-aged woman complains of generalized weakness and nausea. Her blood pressure is 80/50 mm Hg, pulse rate is 40 beats/min and weak, and respirations are 22 breaths/min and regular. She is receiving supplemental oxygen, and an IV line has been established in the extremity opposite the shunt. The ECG reveals sinus bradycardia in lead II. Your next action should be to:
    A) obtain a 12-lead ECG tracing.
    B) administer 0.5 mg of atropine sulfate.
    C) administer a 20-mL/kg fluid bolus.
    D) administer calcium and bicarbonate.
A

Ans: B
Page: 1175-1176
Type: Critical Thinking

55
Q
  1. A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, has a pulse rate of 90 beats/min and regular, and has respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should:
    A) recognize that she probably received an overaggressive dialysis treatment.
    B) start an IV line with normal saline and infuse 200 mL of normal saline per hour.
    C) transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure.
    D) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.
A

Ans: D
Page: 1175-1176
Type: Critical Thinking

56
Q 
56.  A 50-year-old man presents with a painful penile erection that has persisted for the past several hours. He is conscious, but restless, and his vital signs are stable. Which of the following conditions could cause his clinical presentation?
A)  Renal failure
B)  Head trauma
C)  Cocaine abuse
D)  Nitroglycerin use
A

Ans: C
Page: 1176
Type: Critical Thinking

Paramedic Midterm (21 decks)

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