[Ex3] - C32 - AP Flashcards
32-1. A patient 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 a decrease in renal blood flow, or peritubular capillary
pressure, or stimulation of the antidiuretic hormone.
32-2. A patient 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. Compensation for such a situation would not include atrophy or a
change in cell structure of the remaining kidney. Renal failure would be avoided.
32-3. A 55 year old presents reporting urinary retention. Tests reveal 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 would. Neither
glomerulonephritis nor increased bladder compliance causes the stasis that would lead to
calculus formation.
32-4. What is the most common type of renal stone composed of?
a. Struvite
b. Cystine
c. Calcium
d. Uric acid
ANS: C
The most common stone types are calcium oxalate or phosphate (70%–80%). Struvite
(magnesium-ammonium-phosphate) occurs 15% of the time. Cystine stones are rare (less than
1%). Uric acid stones occur 7% of the time.
32-5. 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, not gender, although calculi
form more often in men. Neither body temperature nor serum mineral concentrations are as
important as urine pH.
32-6. A patient is diagnosed with renal calculus that is causing a urinary obstruction. Which
symptoms would be most likely experienced?
a. Anuria
b. Hematuria
c. Pyuria
d. Flank pain
ANS: D
Significant flank pain is the most common manifestation. Neither anuria nor pyuria is a
common manifestation. Hematuria does occur, but it is not the most common manifestation.
32-7 When a patient’s CT scan reveals a lesion above the pontine micturition center, which
condition 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.
32-8. A 75 year old reports loss of urine with cough, sneezing, or laughing. These symptoms
support which diagnosis?
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.
32-9. Which is the most beneficial medication treatment for a patient experiencing detrusor
sphincter dyssynergia?
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. Treatment for detrusor sphincter dyssynergia is not associated
with beta-blockers, vasodilators, or diuretics.
32-10. A 29-year-old female presents with cloudy urine, flank pain, and hematuria. These signs and
symptoms support which diagnosis?
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, they are 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.
32-11. A 25-year-old female is 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 E. coli. Urinary tract
infections are not associated with Streptococcus, C. albicans, or Chlamydia.
32-12. When considering pyelonephritis, where is the site of the infection?
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 not associated with the bladder, renal tubules, or glomerulus.
32-13. 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. Risk factors do not include cystitis, renal cancer, or nephrotic syndrome.
32-14. A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria
exceeding 3–5 grams per 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: (i) hematuria with
red blood cell casts and (ii) proteinuria exceeding 3–5 grams per day with albumin
(macroalbuminuria) as the major protein. Cystitis is not associated with proteinuria and so is
not relevant to the diagnosis of glomerulonephritis. Chronic pyelonephritis is manifested by
dysuria, not proteinuria. Proteinuria is not seen with renal calculi.
32-15. Acute poststreptococcal glomerulonephritis is primarily caused by:
a. swelling of mesangial cells in the Bowman space in response to the presence of
bacteria.
b. immune 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. It is not an
inflammatory process nor is it caused by an accumulation of antiglomerular basement
membrane antibodies.
