Genitourinary Renal Emergencies

Question 1

What structures may be affected in a urinary tract infection in a female patient?
Question 1 options:

A)

Urethra, bladder, kidney

B)

Vagina, bladder, urethra

C)

Kidney, bladder, Fallopian tubes

D)

Bladder, ureters, vagina

Answer 1

urethra, bladder, kidneys

Question 2

Which of the following statements best explains why urinary tract infections are more common in females than in males?
Question 2 options:

A)

The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract.

B)

Males have more acidic urine, which is effective in eliminating bacteria from the urinary tract.

C)

The presence of estrogen in the lining of the female reproductive tract makes the mucous membranes more prone to infection.

D)

Bacteria from the vagina commonly enter the female urethra.

Answer 2

the female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract

Question 3

Of the following, which is TRUE of the changes in blood chemistry and composition in a patient with chronic renal failure?
Question 3 options:

A)

Urea and creatinine levels increase.

B)

Polycythemia occurs.

C)

Blood glucose decreases.

D)

H+ excretion leads to alkalosis.

Answer 3

urea and creatinine levels increase

Question 4

Which of the following would most increase the likelihood of a urinary tract infection?
Question 4 options:

A)

Lack of sexual activity

B)

Prior history of renal calculi

C)

Urinary stasis

D)

Male gender

Answer 4

urinary stasis

Question 5

Tenderness associated with pyelonephritis is best evaluated by percussing:
Question 5 options:

A)

over the pubis in lower UTI and at the flank in upper UTI.

B)

laterally, just superior to the superior iliac crest.

C)

just lateral to the spine slightly superior to the sacroiliac joint.

D)

in the midline, just superior to the symphysis pubis.

Answer 5

just lateral to the spine slightly superior to the sacroiliac joint

Question 6

A patient undergoes neurological changes during hemodialysis. Of the following, which is the most likely cause of these neurologic abnormalities?
Question 6 options:

A)

Hyperglycemia

B)

Hypotension

C)

Accumulated blood urea

D)

Acute myocardial infarction

Answer 6

hypotension

Question 7

Your patient is a 30-year-old male complaining of pain radiating from the left flank into the groin. He states that it began as a vague pain in his flank, then became very sharp and radiating. Based on his description of his pain, you would also expect him to complain of:
Question 7 options:

A)

painful urination.

B)

purulent urethral discharge.

C)

inability to urinate.

D)

fever.

Answer 7

painful urination

Question 8

Treatment of a patient in acute renal failure may include all of the following EXCEPT:
Question 8 options:

A)

potassium.

B)

dialysis.

C)

IV normal saline.

D)

furosemide.

Answer 8

potassium

Question 9

Fifty percent dextrose solution is placed on side A of a membrane, and 25 percent dextrose is placed on side B of a membrane. Assuming the membrane is permeable to water, but not solutes, what will happen?
Question 9 options:

A)

Water will not move in either direction.

B)

Net movement of water from side A to side B will occur.

C)

Water may move freely in both directions, but there will be no net movement of water.

D)

Net movement of water from side B to side A will occur.

Answer 9

net movement of water from side B to side A will occur

Question 10

A 76-year-old patient with acute interstitial nephritis presents with oliguria, altered mental status, and edema to his face, hands, and feet. Of the following, which best describes the pathophysiology behind these clinical findings?
Question 10 options:

A)

H+ excretion results in diuresis and alkalosis.

B)

Increased GFR results in retention of water, electrolytes, and metabolic waste.

C)

Na+ and K+ excretion results in diuresis and dehydration.

D)

Decreased GFR results in retention of water, electrolytes, and metabolic waste.

Answer 10

decreased GFR results in retention of water, electrolytes and metabolic waste

Question 11

Your patient is a 32-year-old female who is alert and complaining of dysuria. She describes a three-day history of pain with urination and urinary urgency and difficulty. She describes the pain as a 5 on a scale of 0 to 10. Physical examination reveals tenderness on palpation of the lower abdomen bilaterally and warm, dry skin. HR = 88, BP = 126/78, RR = 12. The most appropriate action is:
Question 11 options:

A)

Expedite transport in position of comfort.

B)

oxygen, IV fluids, morphine.

C)

IV fluids, morphine.

D)

oxygen, IV fluids.

Answer 11

expedite transport in position of comfort

Question 12

Which of the following statements about hemodialysis is TRUE?
Question 12 options:

A)

Blood is removed from the body, wastes are collected in a filter, and blood is then returned to the body.

B)

Dialysate enters the circulation through the venous site of a fistula and leaves through the arterial side of the fistula.

C)

Dialysate is placed in the abdominal cavity, the peritoneum acts as a dialysis membrane, and dialysate is then removed from the abdominal cavity.

D)

Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side.

Answer 12

dialysis is approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side

Question 13

In healthy individuals, which of the following is NOT a function of the kidney?
Question 13 options:

A)

Excretion of glucose

B)

Regulation of water and electrolyte balance and pH

C)

Secretion of erythropoietin

D)

Excretion of wastes

Answer 13

excretion of glucose

Question 14

All of the following are common complications of renal dialysis EXCEPT:
Question 14 options:

A)

localized infection at the needle puncture site.

B)

bleeding from the needle puncture site.

C)

dysfunction of the fistula.

D)

air embolism.

Answer 14

air embolism

Question 15

Which of the following findings is most suggestive of cystitis?
Question 15 options:

A)

Abdominal distension

B)

Diffuse, periumbilical abdominal pain

C)

Flank pain radiating to the groin

D)

Suprapubic tenderness to palpation

Answer 15

suprapubic tenderness to palpation

Question 16

A patient with no prior history of renal disease is experiencing restlessness, agitation, dysuria, and flank pain radiating into the groin. Appropriate treatment for this patient would consist of all of the following EXCEPT:
Question 16 options:

A)

morphine.

B)

Lasix IV.

C)

IV fluid therapy.

D)

fentanyl.

Answer 16

Lasix IV

Question 17

All of the following may be associated with urinary tract infection EXCEPT:
Question 17 options:

A)

prostatitis.

B)

cholecystitis.

C)

pyelonephritis.

D)

cystitis.

Answer 17

cholecystitis

Question 18

Your patient is an 83-year-old male with a fever of 103°F. In addition, the patient is confused and combative. Heart rate = 132, respirations = 20, blood pressure = 100/70, SpO2 95% on room air, and blood glucose level = 90 mg/dL. During your examination you note that the patient has a Foley catheter and that the collection bag appears not to have been emptied for quite some time. The bag is full of dark, cloudy urine with sediment at the bottom of the bag. Which of the following is most appropriate?
Question 18 options:

A)

BLS transport without intervention

B)

Acetaminophen suppository

C)

Intravenous fluid therapy with normal saline

D)

Furosemide

Answer 18

intravenous fluid therapy with normal saline

Question 19

Which of the following is least likely to lead to acute renal failure?
Question 19 options:

A)

Heart failure with hypotension

B)

Interstitial nephritis

C)

Urethral obstruction

D)

Pneumonia

Answer 19

pneumonia

Question 20

Your patient is a 68-year-old male who is conscious but confused and lying on his kitchen floor. The patient offers no complaint other than wishing to be helped up from the floor. The patient can tell you that he “slipped a few days ago” and has been on the floor since. Physical examination reveals dry, cool skin; dry mucous membranes; clear lung sounds bilaterally; and no indications of trauma. HR = 112, BP = 98/70, RR = 14, SaO2 = 96%. Your partner finds an appointment card indicating the patient missed a hemodialysis appointment two days ago. Which of the following is the best course for managing this patient?
Question 20 options:

A)

1,000 mL fluid bolus

B)

250 mL fluid bolus

C)

Dopamine infusion

D)

IV of NS at a keep-open rate

Answer 20

250 mL fluid bolus

Question 21

All of the following symptoms are consistent with urinary tract infection EXCEPT:
Question 21 options:

A)

tenderness over one or both flanks.

B)

frequent urge to urinate.

C)

difficulty beginning and continuing to void.

D)

passing hard, granular material in the urine.

Answer 21

passing hard granular material in the urine

Question 22

Which of the following would interfere with urine production?
Question 22 options:

A)

Tumor in the renal pelvis

B)

Benign prostatic hypertrophy

C)

Renal calculi

D)

Toxic damage to the nephrons

Answer 22

toxic damage to the nephrons

Question 23

Which of the following best describes the mechanism of action of ACE inhibitors?
Question 23 options:

A)

They inhibit the conversion of angiotensin I to angiotensin II.

B)

They inhibit sodium reabsorption, causing increased excretion of sodium.

C)

They inhibit the formation of renin in the renin-angiotensin system.

D)

They increase the GFR directly.

Answer 23

they inhibit the conversion of angiotension to angiotension II

Question 24

Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located?
Question 24 options:

A)

Testes

B)

Lower left or right quadrant, depending on which side is affected

C)

Suprapubic region

D)

Flank

Answer 24

testes

Question 25

Your patient is a 68-year-old female who is conscious but confused and lying supine in bed without complaint. Her daughter states that the patient was recently diagnosed with a bladder infection and has been taking antibiotics. She also states that her mother has not produced urine for two days, during which she has become increasingly confused. Physical examination reveals swelling to the face, hands, and feet; cool and moist skin; and lung sounds that are clear and equal bilaterally. HR = 104, BP = 142/88, RR = 14, SaO2 = 96%. In addition to administering oxygen and monitoring the cardiac rhythm, which of the following courses of action is most appropriate?
Question 25 options:

A)

IV of NS KVO

B)

IV of NS with 250 cc fluid challenge

C)

12-lead ECG, IV of NS KVO

D)

IV of NS KVO, furosemide, 40 mg

Answer 25

12 lead ECG, IV of NS KVO

Question 26

Your patient has a history of benign prostatic hypertrophy. Which of the following complaints is most consistent with this history?
Question 26 options:

A)

“I can’t seem to urinate.”

B)

“I have blood in my urine first thing in the morning.”

C)

“It seems like I urinate a gallon at a time.”

D)

“My urine is cloudy and has a strong odor.”

Answer 26

I cant seem to urinate

Question 27

Your patient is a 35-year-old male whom you suspect of having a kidney stone. All of the following would be consistent with this impression EXCEPT:
Question 27 options:

A)

restlessness.

B)

hematuria.

C)

a description of “knifelike” pain.

D)

fever.

Answer 27

fever

Question 28

You are called to a local physician’s office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient’s wife brought him in because he has had a “chest cold,” missed dialysis yesterday, and is now “acting strangely.” Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO2 = 97%, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep-open rate, which of the following is most appropriate for this patient in the prehospital setting?
Question 28 options:

A)

IV dextrose, 25 gm

B)

IV magnesium sulfate, 10 gm

C)

IV sodium bicarbonate, 1 mEq/kg

D)

IV furosemide, 120 mg

Answer 28

IV sodium bicarbonate 1mEq/kg

Question 29

The leading cause(s) of end-stage renal failure is (are):
Question 29 options:

A)

uncontrolled diabetes mellitus and hypertension.

B)

acute renal failure.

C)

kidney infection.

D)

renal calculi and kidney infection.

Answer 29

uncontrolled diabetes melitus and hypertension

Question 30

Which of the following statements about chronic renal failure (CRF) is accurate?
Question 30 options:

A)

Hemodialysis can reverse CRF, but CAPD cannot.

B)

The only treatment for CRF is a kidney transplant.

C)

CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable.

D)

CRF is reversible if the cause is found and treated.

Answer 30

CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable

Question 31

Oxygen can benefit patients with chronic renal failure because it is common for patients with chronic renal failure to be:
Question 31 options:

A)

anemic due to the blood loss associated with hemodialysis.

B)

hypoxic secondary to associated congestive heart failure.

C)

hypoxic secondary to associated hypotension.

D)

anemic due to decreased production of RBCs.

Answer 31

anemic due to decreased production of RBC’s

Question 32

On-scene you are presented with a confused patient suffering from altered mental status. Additionally, in front of the family, the patient is very irritable and verbally abusive toward all present, including EMS. His wife states that his “kidneys are no good” and he also has “sugar” problems. Your assessment indicates that he is dyspneic with pale skin that is covered with a fine white sediment. His radial pulse is weak, rapid, and irregular. Additionally, you note edema to his hands, feet, and face. Crackles are noted to the lungs bilaterally and he has a dialysis graft on his right forearm. Your partner reports that his heart rate is 164, respirations 26, blood pressure 176/90, and SpO2 89%. After applying high-concentration oxygen, which of the following would you perform next?
Question 32 options:

A)

Administer sodium bicarbonate, 50 mEq

B)

Administer furosemide, 120 mg

C)

Infuse a 1000 mL bolus of NS

D)

Determine the blood glucose level

Answer 32

determine the blood glucose level

Question 33

In order for hemodialysis to be effective in ridding the body of excess electrolytes, which of the following statements must be TRUE?
Question 33 options:

A)

The dialysate must not contain electrolytes.

B)

The dialysate must contain electrolytes in the same concentration as in the patient’s blood.

C)

The dialysate must contain electrolytes in a concentration higher than in the patient’s blood.

D)

The dialysate must contain electrolytes in a concentration lower than in the patient’s blood.

Answer 33

the dialystate must contain electrolytes in a concentration lower than in the patients blood

Question 34

Which of the following statements regarding a dialysis fistula is TRUE?
Question 34 options:

A)

A fistula uses a dual lumen tube to connect an artery and a vein.

B)

A fistula is a surgical anastomosis of an artery and a vein.

C)

The fistula is the preferred site of venous access in an emergency situation.

D)

The fistula is inserted peripherally, but the end of it is placed near the right atrium.

Answer 34

a fistula is a surgical anastomosis of an artery and a vein

Question 35

When assessing a fistula used for hemodialysis, which of the following should concern you?
Question 35 options:

A)

Pulsation with each heartbeat

B)

Bruising around the fistula

C)

Lack of a palpable vibration

D)

A bruit on auscultation

Answer 35

lack of palpable vibration

Question 36

A 40-year-old female presents with hemorrhage from her dialysis graft. She states that she just got back from dialysis when the bleeding started. There is a significant amount of blood on the chair and floor. To control the bleeding, you would immediately:
Question 36 options:

A)

place a tourniquet proximal to the graft.

B)

apply ice to the area and elevate the extremity.

C)

place a tourniquet distal to the graft.

D)

apply direct pressure over the graft.

Answer 36

apply direct pressure to the graft

Question 37

Which of the following is associated with CAPD?
Question 37 options:

A)

Dialysis shunt in either arm

B)

Catheter placed in the central circulation

C)

Catheter providing access to the abdominal cavity

D)

Dialysis fistula in either arm

Answer 37

dialysis fistula in either arm

Question 38

Which of the following is a prerenal cause of acute renal failure?
Question 38 options:

A)

Embolism of the renal vein

B)

Pyelonephritis

C)

Urethral obstruction due to renal calculi

D)

Massive overdose of ibuprofen

Answer 38

embolism of the renal vein

Question 39

Which of the following chemistry findings would suggest acute renal failure?
Question 39 options:

A)

Elevated blood urea nitrogen (BUN)

B)

Elevated iron

C)

Decreased creatinine

D)

Decreased potassium

Answer 39

elevated blood urea nitrogen (BUN)

Question 40

Ammonia is converted into urea, to be excreted as urine, in which organ?
Question 40 options:

A)

Spleen

B)

Liver

C)

Bladder

D)

Kidney

Answer 40

liver

Question 41

The two main functions of the renal system are:
Question 41 options:

A)

maintaining blood volume with proper pH, and retaining glucose and excreting urea.

B)

maintaining blood glucose and clearing dead blood cells.

C)

maintaining hematocrit levels with the proper creatine balance, and activation of the RAAS.

D)

maintaining pH balance and blood volume.

Answer 41

maintaining blood volume with proper pH and retaining glucose excreting urea

Question 42

Glucose is excreted through the urea above which level?
Question 42 options:

A)

180 mg/dL

B)

500 mg/dL

C)

250 mg/dL

D)

150 mg/dL

Answer 42

180 mg/dL

Question 43

When dealing with a possible renal emergency, it is imperative to ask:
Question 43 options:

A)

“How much do you weigh?”

B)

“How many times have you urinated today?”

C)

“When was the last time you saw your nephrologist?”

D)

“Do you think you can walk?”

Answer 43

how many times have you urinated today

Question 44

You respond to a call of a patient experiencing back pain. Upon your arrival, the patient is curled into the fetal position and feels warm to the touch. You suspect:
Question 44 options:

A)

acute pyelonephritis.

B)

acute renal failure.

C)

acute renal calculi.

D)

acute urinary tract infection.

Answer 44

acute pyelonephritis

Question 45

You respond to a nursing home for an ill patient. Upon your arrival, the staff tells you that over the past few days the patient’s urine output has been steadily declining. Today, the patient has voided only approximately 400 mL. You suspect:
Question 45 options:

A)

acute renal failure.

B)

renal calculi.

C)

chronic renal failure.

D)

pyelonephritis.

Answer 45

acute renal failure

Question 46

Oliguria is defined as:
Question 46 options:

A)

urine output of less than 100-200 mL daily.

B)

urine output of less than 1000-2000 mL daily.

C)

urine output of less than 4000-5000 mL daily.

D)

urine output of less than 400-500 mL daily.

Answer 46

urine output of less than 400- 500 mL daily

Question 47

Acute renal failure occurs when a patient loses ________ of the functioning nephrons.
Question 47 options:

A)

60%

B)

50%

C)

80%

D)

70%

Answer 47

70%

Question 48

You respond to an ill patient. You note that the patient appears jaundiced and has a white frosty dust on his skin. You suspect:
Question 48 options:

A)

renal frost.

B)

scabies.

C)

uremic frost.

D)

eczema.

Answer 48

uremic frost

Question 49

You respond to a call of an ill male patient. Upon arrival, you see a patient in a chair, hooked into two large bags—one on an IV stand, one below his waist. The tubes are going into the patient’s abdomen. You should suspect that this patient is undergoing:
Question 49 options:

A)

peritoneal dialysis.

B)

hemodialysis.

C)

gastric lavage.

D)

J tube feeding.

Answer 49

peritoneal dialysis