Renal and Urinary Tract

Question 1

Which of the following is a cause of prerenal disease in acute kidney injury?
A Nephrotoxic agents
B Dehydration
C Renal calculi
D Benign prostatic hypertrophy

Answer 1

inadequate kidney perfusion r/t DEHYDRATION

Question 2

A new patient, a 54-year-old male with a history of cigarette smoking, obesity, and uncontrolled hypertension, presents with new-onset hematuria, dull and aching flank pain, and a palpable flank mass. The diagnosis confirms an advanced stage of renal tumor. Which of the following statements about renal tumors is incorrect?
A. Earlier stages are often silent, with painless hematuria being the most common symptom.

B. 25% to 30% of individuals with renal cell carcinoma (RCC) present with metastasis.

C. Hemolytic uremic syndrome (HUS) is commonly seen in patients with RCC.

D. Clear cell RCC is the most common renal neoplasm and accounts for about 2% of cancer-related deaths.

Answer 2

Hemolytic uremic syndrome (HUS) is an acute disorder characterized by hemolytic anemia, thrombocytopenia (a decrease in blood platelets), and acute renal failure. HUS is a thrombotic microangiopathy and is the most common cause of community-acquired acute kidney injury in children. It most frequently occurs in infants and children under the age of 4, though it can also affect adolescents and adults. HUS is not commonly associated with renal cell carcinoma (RCC

Question 3

Which of the following statements about incontinence in children is incorrect?

A. Primary incontinence occurs when a child who has been dry for at least 6 months becomes incontinent again, while secondary incontinence occurs when a child has not developed bladder control beyond the age at which bladder control is typically achieved.

B. Incontinence in children can be related to urinary tract infections (UTIs), neurologic disturbances, congenital defects of the bladder, urethra, or bladder neck, as well as allergies.

C. Altered sleep arousal or obstructive sleep apnea may be associated with enuresis.

D. Stressful psychological situations, such as the arrival of a new sibling, may cause incontinence or enuresis to develop.

E. Constipation is frequently present in children with urinary incontinence.

Answer 3

Primary incontinence occurs when a child who has been dry for at least 6 months becomes incontinent again, while secondary incontinence occurs when a child has not developed bladder control beyond the age at which bladder control is typically achieved.

Question 4

Which of the following ordinarily reduces the risk of stone formation?

A Presence of potassium citrate, magnesium, pyrophosphate, and Tamm Horsefall protein (uromodulin)

B lower than normal concentration of solute in solvent (i.e salts in urine)

C. Having already had 2 stones within the past 5 years

D. Male gender at birth over 50 years

Answer 4

Presence of potassium citrate, magnesium, pyrophosphate, and Tamm Horsefall protein (uromodulin)

Question 5

A decrease in which of the following clinical measures would most likely be associated with a decreasing Glomerular Filtration Rate (GFR)?

A. renal blood flow
B serum creatinine
C Blood urea nitrogen
D Creatinine Clearance

Answer 5

renal blood flow

reduce renal blood flow reduces

Question 6

A positive culture for which microbe may co-occur with Acute Glomerulonephritis in children (5-12yrs)?

A. streptococcus pyrogens
B. E. Coli
C. Psuedomonas aeruginosa
D P fimbriae

Answer 6

streptococcus pyrogenes

Acute poststreptococcal glomerulonephritis is caused by strains of streptococcus

Question 7

You are educating your patient on ways to reduce their risk of nephrolithiasis recurrence. Each of the following would be good advice, except:
A Maintain a dietary calcium intake of 1000-1200mg/day
B Drink cranberry juice to promote more acidic urine
C Minimize high oxalate-containing foods like spinach, beets and nuts
D Maintain good fluid intake to generate >2.5L UOP daily

Answer 7

Drink cranberry juice to promote more acidic urine

Question 8

NSAID-induced kidney injury would be considered which type of AKI?
A Pre-renal
B Intrarenal
C Post-renal

Answer 8

Pre-renal causes of AKI are related to decreased kidney perfusion, often from hypovolemia, reduced cardiac output, and systemic vasodilation.

NOT Intrarenal AKI is typically caused by acute tubular necrosis (from surgery, shock, hemorrhage, sepsis, burns, and nephrotoxicity from contrast dye, NSAID’s, aminoglycosides, ACE inhibitors, ARBs, antibiotics).

Postrenal causes of AKI are generally from bladder outlet and ureteral obstructions

Question 9

Which of the following statements best describes the role of the countercurrent exchange mechanism in the renal system and how its disruption could affect kidney function?
A The countercurrent exchange system allows for the reabsorption of glucose in the proximal tubule; disruption leads to increased glucose in the urine (glycosuria).
B The countercurrent exchange system facilitates the conservation of water and sodium; disruption leads to decreased concentration of urine and increased sodium excretion.
C The countercurrent exchange system is responsible for the secretion of potassium in the collecting duct; disruption causes hyperkalemia due to decreased potassium excretion.
D The countercurrent exchange system primarily helps in the filtration of plasma; disruption leads to increased protein loss in urine (proteinuria).

Answer 9

The countercurrent exchange system facilitates the conservation of water and sodium; disruption leads to decreased concentration of urine and increased sodium excretion.

The countercurrent exchange system in the renal nephron, particularly in the loop of Henle, plays a crucial role in concentrating urine and conserving water and sodium. Disruption of this mechanism can result in an inability to concentrate urine, ultimately leading to increased urine output and electrolyte imbalances.

Question 10

A 45-year-old male presents to the clinic with complaints of difficulty urinating. He reports a weak urinary stream, a sensation of incomplete bladder emptying, and occasionally experiences a painful urination. His medical history includes a traumatic injury to the pelvis from a car accident five years ago, for which he underwent surgery. Upon examination, the physician notes a distended bladder and performs a cystoscopy, revealing a narrowing in the posterior urethra. What is the most likely cause of this patient’s urethral stricture?

A Congenital abnormality
B Infection
C Previous trauma and surgical intervention
D Benign prostatic hyperplasia

Answer 10

Previous trauma and surgical intervention. Urethral strictures are often caused by trauma, particularly in the case of pelvic injuries or surgical procedures in the region. In this patient, the history of pelvic trauma and subsequent surgery are likely contributors to the development of the stricture.

Question 11

A 10-year-old girl is brought to the pediatric clinic by her mother, who reports that her daughter had a recent upper respiratory infection about two weeks ago. Since then, she has developed swelling in her face, especially in the morning, and her urine appears dark and foamy. The mother also mentions that the child has been feeling fatigued and has had a mild headache. Upon examination, the child is found to have hypertension and periorbital edema. Urinalysis reveals hematuria and proteinuria, and blood tests show elevated serum creatinine and low complement levels. What is the most likely underlying cause of this child’s condition?

A Bacterial endocarditis
B Previous streptococcal infection
C Systemic lupus erythematosus
D Diabetic nephropathy

Answer 11

Previous streptococcal infection : The combination of periorbital edema, hypertension, hematuria, and proteinuria is characteristic of PSGN, a renal complication that can occur after a streptococcal infection. These symptoms align well with typical presentations seen in children following such infections.

Question 12

George is a nurse practitioner student who is presenting a project to the class on the topic of nephrolithiasis. Which of the following statements about potential risk factors are incorrect

A Males are at higher risk for developing kidney stones
B A decreased fluid intake helps prevent kidney stones from forming
C There is a high risk of recurrence after developing a kidney stone
D Geographic region influence the risk of developing a kidney stone

Answer 12

A decreased fluid intake helps prevent kidney stones from forming

Question 13

Which of the following types of cystitis is being described: on cystoscopy, the bladder appearance is hyperemic and inflamed, with mucosal pus formation.

A Hemorrhagic cystitis
B Suppurative cystitis
C Ulcerative cystitis
D Gangrenous cystitis

Answer 13

Suppurative cystitis

NOT

ulcerative cystitis shows sloughing of mucosa

gangrenous cystitis shows necrosis of the bladder wall

Question 14

Which of the following clinical manifestations is not associated with nephroblastoma?

A Hematuria
B Abdominal mass confined to one side
C Hypotension
D Fever

Answer 14

Hypertension may present with nephroblastoma because of the excessive secretion of renin by the tumor

Question 15

What is the most common bacteria causing bacterial cystitis?

A E. coli

B S. saprophyticus

C Klebsiella

D Pseudomonas

Answer 15

E. Coli —The most common infectious agent of UTI is E. coli, this is a commonly occurring bacteria of the GI flora.

Question 16

All are clinical manifestations of nephrotic syndrome except?

A. Proteinuria

B Decreased vitamin D

C Hyperalbuminemia

D Lipiduria

Answer 16

hyperalbuminemia– because Hypoalbuminemia is a clinical manifestation of nephrotic syndrome

Question 17

A 2 year old male patient presents to the clinic with one week of diarrhea with blood in the stool. One week after the diarrhea subsided the patient had symptoms of pallor, bruising, weakness, lethargy and abdominal pain. Labs show metabolic acidosis, azotemia, hyperkalemia, anemia and thrombocytopenia. What is a likely diagnosis for this patient?

A Wilms tumor

B Hemolytic uremic syndrome

C Nephrotic syndrome

D Polycystic kidney disease

Answer 17

Hemolytic uremic syndrome

this syndrome associated with diarrhea is associated with a viral or bacterial agent that is absorbed by the GI tract then brought to the kidneys by WBCs. When the WBCs enter the kidneys there is damage done to the glomerular membranes causing hematuria and the clotting cascade. This causes hemolytic anemia and thrombocytopenia. The patient will have symptoms of AKI, hemolytic anemia and thrombocytopenia.

Question 18

A 50 year old male patient with a history of recurrent kidney stones is being discharged. As the advanced practice nurse you realize this patient needs more education regarding dietary modification when he says:

A. “I have been eating more veggies and beans and less animal meat”

B. “I stopped adding salt to my food because it also helps with my blood pressure”

C. “I switched to drinking iced tea instead of soda”

D. “I drink 2-3 liters of water a day”

Answer 18

“I switched to drinking iced tea instead of soda”

Question 19

Which statement regarding Over and under active bladders is correct:

A. Overactive bladder symptoms include urinary urgency, frequency, and nocturia

B. Underactive bladder can be associated with spinal cord injury, stroke, multiple sclerosis and Parkinson’s disease

C. Neuromodulation and drug therapy can be used in treatment of both bladder disorders

D. All of the above

Answer 19

All of the above

Question 20

A 65 year old male presents complaining of difficulty urinating and urgency and “leaking urine”. States he has noticed some blood in his urine and frequency over the last couple of days but denies any pain with urination and also denies any abdominal or flank pain. Bladder scan reveals 728mL of urine in bladder and patient is unable to void. A urinary catheter is placed and gross blood in urine is returned with multiple clots. Pt denies being on any blood thinners. You are concerned this patient has:

A. Benign Prostate Hypertrophy

B. Cystitis

C. Bladder Cancer

D. Neurogenic bladder

Answer 20

Bladder Cancer

Question 21

A patient arrives at your primary clinic for a wellness check. The patient states that he has been having lower flank pain for the past two days, and hasn’t been able to produce urine for the last 8 hours despite high levels of hydration. The patient also states that he has a history of recurrent urinary tract infections. Which of these would be your priority intervention?

A Recommend more oral intake of fluids

B Start on broad-spectrum PO antibiotics

C Dietary review for foods high in purine

D Transfer of care to the nearest emergency facility

Answer 21

Transfer care to the nearest emergency facility– This patient is presenting with signs of an obstructional kidney stone with UTI, which is a medical emergency and requires surgical intervention to remove the stone to prevent the patient from going septic

Question 22

Grace is following up with your clinic after a recent hospitalization due to a urinary tract infection. While monitoring her lab values, you notice her serum creatinine levels are 2.0, BUN of 28, and urine osmolality of 1.020. What statement from Grace would prompt further education?

A I don’t wanna work my kidneys too hard after the hospital, so I’ve been drinking less fluids

B My doctor told me my heart medications weren’t harmful to my kidneys, so I’m still taking them

C I’m watching closely how much food with potassium I’m eating, per what my nurse told me

D I’m making sure to take my antibiotic twice a day like the pharmacist told me

Answer 22

I don’t wanna work my kidneys too hard after the hospital, so I’ve been drinking less fluids — Patients that are at risk for acute kidney injury, especially after a urinary infection, require adequate fluid intake to support cardiovascular function and output, which can assist the kidneys in recovering via better perfusion

Question 23

A 4-year-old girl is diagnosed with grade II Vesicoureteral Reflux (VUR) after recurrent urinary tract infections. Her parents are concerned about how VUR will affect her future health. Which of the following statements about VUR is accurate and should be included?

A VUR is unrelated to the risk of kidney damage and long-term renal function.

B Children with VUR should avoid all physical activity to prevent further kidney damage.

C Antibiotic prophylaxis is often used to prevent recurrent UTIs in children with VUR.

D VUR is often treated with surgery immediately upon diagnosis to prevent kidney damage.

Answer 23

Prompt treatment of UTIs are essential to prevent renal scarring and pyelonephritis in children that have VUR

Question 24

An 18-year-old female presents to the emergency department with complaints of flank pain, urinary frequency, urgency, and dysuria. You conduct a urinalysis on this patient and discover bacteriuria positive nitrates and leukocyte esterase. Which diagnosis would you expect for this patient?

A. Renal Colic

B. Cystitis

C. Bladder tumor

D. Kidney tumor

Answer 24

Cystitis (correct) – clinical manifestations include polyuria, urinary frequency, urgency, dysuria, flank pain, cloudy urine, urinalysis of positive nitrates and leukocyte esterase

Question 25

What systemic effect can chronic kidney disease have on the cardiopulmonary system?

A. Cardiomyopathy

B. Anemia

C. Pulmonary edema

D. Sexual dysfunction

Answer 25

Pulmonary edema (correct) – this is a systemic effect caused by chronic kidney disease and is associated with the cardiopulmonary system

Question 26

A 3-year-old presents to their primary care physician with complaints of abdominal swelling and hematuria, which diagnosis would you expect for this patient?

A. Hemolytic uremic syndrome

B. Hypospadias

C. Nephrotic syndrome

D. Nephroblastoma

Answer 26

Nephroblastoma (correct) – most children are diagnosed before the age of 5, clinical manifestations include abdominal swelling, hematuria, and fever

Question 27

A 75-year-old female presents to her primary care provider’s office due to having gastroenteritis. For the past several days, she has been nauseous with diarrhea and vomiting while being unable to tolerate a PO diet. Lab work shows that she is severely dehydrated but has no demonstrated flank pain. Imaging reveals that there are no signs of obstruction. The practitioner diagnoses the patient with an acute kidney injury (AKI). Which one of the following selections is the type of AKI that the patient is experiencing?

A Prerenal AKI.
B Intrarenal AKI.
C Postrenal AKI.
D Chronic kidney disease.

Answer 27

Prerenal AKI.

An AKI can result from ischemic injury related to renal hypoperfusion, sepsis, drug use, infection, extracellular volume depletion, or an obstruction, leading to a sudden decline in kidney function

Question 28

A 58-year-old female presents to her annual physical at her primary care provider’s office. She states that over the past year since her last physical, she has had involuntary urine leakage whenever she coughs, laughs, or needs to lift heavier objects. The exam shows no signs of neurologic impairment, and she does not have a history or a current urinary tract infection (UTI). The provider is considering urinary incontinence as the diagnosis, but which is the most likely type?

A Urge incontinence.
B Stress incontinence.
C Overflow incontinence.
D Functional incontinence.

Answer 28

Stress incontinence.

Stress incontinence is the most common form of incontinence in women under the age of 60 and is the involuntary loss of urine while laughing, coughing, sneezing, or other activities that cause increased pressure in the abdomen

Question 29

A 75-year-old male reports to the local urgent care facility due to having issues urinating. His symptoms include having difficulty initiating urination, having a weak urinary stream, frequent daytime voiding, and having a sense of incomplete bladder emptying. During examination, it is determined that the patient has an enlarged prostate, with no other findings. Based on the symptoms and findings of the examination, which of the following is the most likely cause of his resisted urinary flow?

A Urethral stricture
B Urinary tract infection (UTI).
C Bladder outlet obstruction.
D Pelvic organ prolapse.

Answer 29

Bladder outlet obstruction.

Bladder outlet obstruction has a variety of symptoms, including the need to frequently void during the day, poor force of urine stream, feelings of incomplete bladder emptying, and urinary urgency followed by hesitancy (Rogers & Brashers, 2023, p. 1238). If this obstruction persists, it can cause the bladder to lose its ability to stretch and contract, leading to further urinary retention and symptoms.

Question 30

An athlete with a history of type 2 diabetes presents to the clinic reporting new onset of generalized myalgia, muscle weakness, and brown colored urine “not a lot about a small cup full for the day”. She recently completes the Brooklyn marathon and takes high doses of Advil for the myalgia. Upon chart review, the patient had an annual physical 2 days ago the SCr has now increased 2x from the baseline. The NP’s initial thought for this patient would be:

A Pyelonephritis
B Hypervolemia
C New onset of a viral infection
D Acute renal injury

Answer 30

Acute renal injury

Classic signs of AKI are increased SCr and decreased GFR. Patient may report rash, fever, joint pains and altered urinary excretion

Question 31

The NP is caring for a child recently diagnosed with nephrotic syndrome. The NP understands that nephrotic syndrome is associated with:

A. Tenting skin
B Constipation
C Generalized edema
D Hematuria

Answer 31

Generalized edema

Rationale: Onset of nephrotic syndrome is insidious with swollen eyes as the first sign that does away during the day.

Question 32

Kelsey is a nurse practitioner working in a skilled nursing facility. She is caring for an 82-year old woman with no history of renal or urinary problems. Which of the following clinical manifestations would lead Kelsey to believe this patient may have a urinary tract infection?

A. Urinary retention

B New onset confusion

C. High fever

D. Painless hematuria

Answer 32

New onset confusion

Question 33

Which of the following is not a cause of chronic pyelonephritis?

A Chronic UTIs

B Drug toxicity

C Family history

D Vesicoureteral reflux

Answer 33

Family history

Chronic pyelonephritis can be idiopathic or caused by chronic UTIs, vesicoureteral reflux, kidney stone obstructive uropathy, drug toxicity from analgesics or NSAIDs, ischemia, irradiation, and immune diseases

Question 34

Joey is a nurse practitioner who is caring for a patient with chronic kidney disease (CKD). The patient’s GFR is 23 mL/min, potassium is 5.3, and has pitting edema of the lower extremities. Which stage of CKD is the patient in?

A I

B II

C III

D IV

E V

Answer 34

IV

This patient is in Stage IV of chronic kidney disease which is characterized primarily by the GFR level, but the patient is experiencing other manifestations consistent with this stage as well

Question 35

A patient with a history of diabetes presents with elevated blood glucose levels and reports noticing glucose in his urine. What is the most likely reason for the presence of glucose in this patient’s urine?

A The kidneys are not filtering enough glucose.

B. The sodium-glucose cotransporter 2 (SGLT2) has reached its saturation point.

C. The patient is not consuming enough carbohydrates for energy.

D. The reabsorption of glucose in the proximal tubule has been inhibited by insulin.

Answer 35

The sodium-glucose cotransporter 2 (SGLT2) has reached its saturation point.

SGLT2 is responsible for reabsorbing nearly all filtered glucose in the proximal tubule. However, when plasma glucose levels exceed the renal threshold, SGLT2 reaches its saturation point, and the kidneys can no longer reabsorb all glucose, leading to its appearance in the urine. This is commonly seen in patients with uncontrolled diabetes.

Question 36

A client with stage 3 chronic kidney disease (CKD) has presented to the clinic with complaints of feeling more fatigued than usual. What is the most important information for the nurse practitioner to convey to the client regarding the progression of chronic kidney disease and associated management?

A Regularly monitoring creatinine and urea levels is essential in stage 3 CKD.

B Fluid intake should be increased to help improve kidney filtration at this stage.

C Iron supplements are usually not needed in stage 3 CKD.

D Salt intake does not need to be restricted until stage 5 CKD.

Answer 36

Regularly monitoring creatinine and urea levels is essential in stage 3 CKD. – in stage 3 CKD, moderate kidney damage can lead to rising creatinine and urea levels, which indicate the kidneys’ filtering capacity is diminished. Regular monitoring helps in assessing disease progression and adjusting management plans as needed to prevent further kidney damage.

Question 37

A neonate is diagnosed with hydronephrosis caused by ureteropelvic junction (UPJ) obstruction. What is the primary cause of UPJ obstruction in neonates?

A Intrinsic malformation of smooth muscle or urothelial development
B Excessive fluid intake during pregnancy
C Presence of kidney stones
D Bladder dysfunction

Answer 37

Intrinsic malformation of smooth muscle or urothelial development

because the most common cause of UPJ obstruction in neonates is an intrinsic malformation affecting the smooth muscle or urothelial development, leading to blockage where the renal pelvis meets the ureter.

Question 38

An athlete with a history of type 2 diabetes presents to the clinic reporting new onset of generalized myalgia, muscle weakness, and brown colored urine “not a lot about a small cup full for the day”. She recently completed the Brooklyn marathon and takes high doses of Advil for the myalgia. If not treated, the NP understands that the patient can get:
Hypokalemia
Fluid volume overload
No concern because a viral infection is self-limiting
End Stage Renal Disease

Answer 38

Acute kidney injury results from ischemic injury related to extracellular volume depletion, renal hypoperfusion. When the condition is left untreated it will alter renal function, and when less than 10% of kidney function remains it is called ESRD