Chapter 7: Urinary

Question 1

1. Although urinary obstruction and urinary incontinence have almost opposite effects on urination, they can both result from:
   A) bladder structure changes.
   B) bladder wall atrophy.
   C) micturition reflex spasms.
   D) bladder distensibility loss.

Answer 1

A) bladder structure changes

Question 2

2. The body compensates for obstructed urine outflow. Compensatory changes to chronic obstruction include:
   A) bladder spasms.
   B) urinary frequency.
   C) high residual volume.
   D) overflow incontinence.

Answer 2

B) urinary frequency.

Question 3

3. A patient fell off a ladder and sustained a spinal cord injury that has resulted in bladder dysfunction. During the period immediately after the spinal injury, spinal shock develops and the bladder has function.
   A) atonic
   B) spasmodic
   C) uninhibited
   D) hyperactive

Answer 3

A) atonic

Question 4

4. In men, the condition of nonrelaxing external sphincter with urine retention is commonly caused by:
   A) psychosocial disorders.
   B) prostate enlargement.
   C) chronic stress response.
   D) pelvic inflammatory disease.

Answer 4

B) prostate enlargement.

Question 5

5. In women, pelvic floor weakness may cause which type of incontinence?
   A) Urge
   B) Stress
   C) Overflow
   D) Overactive

Answer 5

B) Stress

Question 6

6. Many factors contribute to the incontinence that is common among the elderly. A major factor is increased:
   A) detrusor muscle function.
   B) intake of liquids and water.
   C) urethral closing pressure.
   D) use of multiple medications.

Answer 6

D) use of multiple medications.

Question 7

7. Dysfunction of the muscle contraction can disrupt the ability to expel urine from the bladder.
   A) trigone
   B) sphincter
   C) detrusor
   D) trabeculae

Answer 7

C) detrusor

Question 8

8. Neurologic control of bladder function consists of three main levels or centers. The lower motor neuron spinal cord centers control micturition:
   A) reflexes.
   B) backflow.
   C) inhibition.
   D) coordination.

Answer 8

A) reflexes.

Question 9

9. Prolonged urethral outlet obstruction causes chronic high bladder pressure and overdistension, resulting in the formation of:
   A) detrusor dyssynergia.
   B) cellules.
   C) interstitial cystitis.
   D) sphincter dystonia.

Answer 9

B) cellules.

Question 10

10 The most common sign of epithelial cell bladder cancer is:
.
A) severe oliguria.
B) hyperproteinuria.
C) hyperphosphaturia.
D) painless hematuria.

Answer 10

D) painless hematuria.

Question 11

11 Most common uncomplicated urinary tract infections are caused by
. that enter through the urethra.
A) Pseudomonas
B) Escherichia coli
C) Staphylococcus aureus
D) Group B Streptococcus

Answer 11

B) Escherichia coli

Question 12

12 Although the distal portion of the urethra often contains pathogens, the urine
. formed in the kidney and found in the bladder is sterile because of the:
A) alkaline urine.
B) glomerular filtering.
C) warm temperature.
D) washout phenomenon.

Answer 12

D) washout phenomenon.

Question 13

13 An elderly patient who experiences chronic pain takes opioid analgesics on a
. regular basis, a practice that has resulted in frequent constipation and occasional bowel obstructions. Which of the following problems may directly result from these gastrointestinal disorders?
A) Urinary tract infections
B) Overflow urinary incontinence
C) Bladder cancer
D) Neurogenic bladder

Answer 13

B) Overflow urinary incontinence

Question 14

14 After reviewing the 24-hour intake and output of a hospital patient, the nurse
. suspects that the patient may be experiencing flaccid bladder dysfunction.
Which of the following diagnostic methods is most likely to confirm or rule out whether the patient is retaining urine?
A) Blood test for creatinine, blood urea nitrogen, and glomerular filtration rate
B) Urine test for culture and sensitivity
C) Routine urinalysis
D) Measurement of postvoid residual (PVR) by ultrasound

Answer 14

D) Measurement of postvoid residual (PVR) by ultrasound

Question 15

15 A pregnant woman who is beginning her third trimester has been diagnosed
. with a urinary tract infection (UTI). Which of the following factors most likely predisposed this patient to the development of a UTI?
A) Increased urine alkalinity during pregnancy
B) Hypertrophy of the bladder wall
C) Dilation of the upper urinary structures
D) Spastic peristalsis of the ureters

Answer 15

C) Dilation of the upper urinary structures

Question 16

16 Which of the following signs and symptoms in a 2-year-old child should
. prompt assessment for a urinary tract infection?
A) Unexplained fever and anorexia
B) Decreased urine output and irritability
C) Production of concentrated urine and recurrent nausea
D) Frank hematuria

Answer 16

A) Unexplained fever and anorexia

Question 17

17 Which of the following patients is likely at the greatest risk of developing a
. urinary tract infection?
A) A pregnant woman who has been experiencing urinary frequency
B) A patient with a diagnosis of chronic kidney disease who requires regular hemodialysis
C) A 79-year-old patient with an indwelling catheter
D) A confused, 81-year-old patient who is incontinent of urine

Answer 17

C) A 79-year-old patient with an indwelling catheter

Question 18

18 A woman has sought care because of recurrent urinary tract infections,
. which have been increasing in both frequency and severity. Which of the following factors is likely to contribute to recurrent UTIs?
A) Reflux flow of urine
B) Fluctuations in urine pH
C) Urethral trauma
D) Inadequate fluid intake

Answer 18

A) Reflux flow of urine

Question 19

19 A public health nurse is conducting a health promotion class for a group of
. older adults. Which of the participants following statements demonstrates an accurate understanding of the risk factors for bladder cancer?
A) I suppose I should listen to my doctor and drink more cranberry juice.
B) More than ever, I guess it would worthwhile for me to quit smoking.
C) I can see that preventing bladder cancer is one more benefit of a healthy diet.

D) I think I should be okay because theres no history or bladder cancer in my family that Im aware of.

Answer 19

B) More than ever, I guess it would worthwhile for me to quit smoking.

Question 20

20 Which of the following events would suggest that an individuals physiologic
. response to an obstruction has progressed beyond the compensatory stage and is now in the decompensatory stage?
A) The bladder muscle hypertrophies.
B) The detrusor loses its power of contraction.
C) The ability to suppress urination is diminished.
D) The individual experiences urgency.

Answer 20

B) The detrusor loses its power of contraction.

Question 21

1.The renal artery can become compressed from swelling due
to pyelonephritis.
T or F

Answer 21

true

Question 22

2.Permanent damage to renal function can develop from
abscesses and necrosis.
T or F

Answer 22

true

Question 23

What are the two types of polycystic kidney disease?

Answer 23

Autosomal dominant - most common, mutations on chromosome 16 (PKDI locus) as opposed to chromosome 4
Autosomal recessive - mutations on PKHD1 gene causing decreased or absent fibrocystin involved in kidney development Appears prenatally, infancy or childhood. ** often the more serious of the two

Question 24

Patho of nephrotic syndrome

Answer 24

NephrOtic = pOdOcytes damaged
mass proteinuria (3.5g/day)
hypoalbuminemia
third spacing/edema
lipiduria, hyperlipidemia

Question 25

Patho of Nephritic syndrome

Answer 25

NephrItic syndrome = Inflammatory response of endothelial cells creating crescents that block blood flow causing glomerulonephritis
hematuria (cola urine)
hypertension
fatigue
oliguria

Question 26

Three types of nephritic syndrome

Answer 26

type 1 - anti-glomerular basement membrane antibody disease (type II hypersensitivity, Goodpasture)
type 2 - post infectious glomerulonephritis (immune complex deposits, IgA nephropathy - berger’s)
Type 3 - necrotizing glomerulonephritis

Question 27

What occurs in the proximal convoluted tubule?

Answer 27

-reabsorption of most ultrafiltrate components (urea, glucose, potassium, sodium, creatinine), calcium and phosphate
- secretion of hydrogen ions (bicarb reabsorption to blood)
- calcium reabsorption
- conversion of inactive to active vitamin D
- action of sodium-glucose cotransporter 2 (SGLT2) inhibitors for DM and CHF treatment (allows greater glucose and sodium excretion rather than reabsorption)

Question 28

What occurs in the loop of henle?

Answer 28

• dips into renal medulla (further into medulla = greater concentration gradient and increased fluid exchange)
• descending = urea excreted, water reabsorbed (impenetrable to ions)
• ascending = hyperconcentrated filtrate has ions moving back and forth to establish homeostasis (water is impenetrable) creating hypo-osmotic filtrate
• loop diuretics (lasix, bumex) take effect (targets Na, Cl, K to increase excretion (water follows))

Question 29

What occurs in the distal convoluted tubule?

Answer 29

• reabsorption of NaCl, HCO3, water
• excretion of Hydrogen, K, Urea, NH4, drugs
• ADH and Aldosterone take effect here (increase/decrease Na/H2O depending on BP)
• parathyroid hormone takes effect here = reabsorption of calcium

Question 30

Path of blood to urine out of body

Answer 30

renal artery -> nephrons -> afferent arteriole -> glomerulus -> basement membrane and podocytes
a. protein filled blood -> efferent arteriole -> nephron capillary bed
b. protein free ultra filtrate -> glomerular capsule (bowman’s capsule) -> proximal convoluted tubule -> descending loop of henle -> ascending loop of henle -> distal convoluted tubule -> collecting duct -> renal pelvis -> ureter -> bladder -> urethra & beyond

Question 31

Case 1: A 50-year-old woman presented complaining of burning sensation when urinating and feeling like she has to go every hour for the last day. She denies fever and suprapubic or back pain.

• Past medical history: dyslipidemia and hypertension
• Medications: atorvastatin
• Allergies: sulfa
• Physical examination: temperature 98.5°F; pulse 80 beats/minute; respirations 18 breaths/min; blood pressure 110/66 mmHg; examination unremarkable; no suprapubic or costovertebral angle tenderness; urine dipstick reveals moderate leukocytes and positive nitrites, with all other values within normal limits.

1. What is the most likely diagnosis and pathogen causing this disorder and mode of transmission? Discuss data that support your decision.

Answer 31

The diagnosis is an acute cystitis, most often caused by Escherichia coli, which is part of the normal intestinal flora. Most infections invade the urethra from the meatus from microorganisms in the perineal area. Her dysuria and frequency support the diagnosis.

Question 32

Case 1: A 50-year-old woman presented complaining of burning sensation when urinating and feeling like she has to go every hour for the last day. She denies fever and suprapubic or back pain.

• Past medical history: dyslipidemia and hypertension
• Medications: atorvastatin
• Allergies: sulfa
• Physical examination: temperature 98.5°F; pulse 80 beats/minute; respirations 18 breaths/min; blood pressure 110/66 mmHg; examination unremarkable; no suprapubic or costovertebral angle tenderness; urine dipstick reveals moderate leukocytes and positive nitrites, with all other values within normal limits.What diagnostic test, if any, should be performed? What diagnostic test findings would support your diagnosis?

Answer 32

A urine dipstick along with a urinalysis and urine culture and sensitivity should be performed. The presence of leukocyte esterase and nitrites on a urine dipstick support the diagnosis of acute cystitis. Other findings on the urinalysis that support an acute cystitis would be leukocytes and bacteria. The culture will demonstrate bacteriuria.

Question 33

Case 2: A 45-year-old woman is complaining of urgency and dysuria for the past 2 days. Yesterday, she started getting chills, feels she is getting a fever, and her back hurts.

• Past medical history: UTI 1 year ago
• Medications: none
• Allergies: no known drug allergy (NKDA)
• Physical examination: temperature 100°F, pulse 86 beats/minute; respirations 18 breaths/minute; blood pressure 110/70 mmHg; positive costovertebral angle and suprapubic tenderness, otherwise unremarkable; urine dipstick reveals positive leukocytes but negative for nitrites and blood.

. What is the most likely diagnosis and pathogen causing this disorder and mode of transmission

Answer 33

The diagnosis is acute pyelonephritis, which is most often caused by Escherichia coli, which is part of the normal intestinal flora. Most infections invade the urethra from the meatus from microorganisms in the perineal area. The microorganism ascends through the urethra to the bladder and then moves along the ureters to the kidney.
Urgency and dysuria support the diagnosis. Further support of an ascending urinary tract infection includes fever, chills, and costovertebral angle tenderness.

Question 34

A 13-year-old boy presented to the clinic complaining of a sore throat, fever, nausea, and malaise. The mother reports that he had a sore throat with fever, nausea, and malaise for 4 to 5 days about 1 week ago. She thought he just has a cold and he seemed to get better, so she did not take him in for evaluation. However, 2 days ago his fever, nausea, and malaise returned. She decided to bring him in for an evaluation. She also noted that he has become tachypneic and short of breath. She noted that his eyes were puffy, his ankles were swollen, and his urine was dark and cloudy.

On examination, the child’s blood pressure was 148/100 mmHg, his pulse was 122 beats/minute, and his respirations were 35 breaths/minute. Orbital and ankle edema were present. Crackles were auscultated bilaterally. No heart murmurs were found. Slight tenderness to percussion over the flank areas was noted.

A chest X-ray showed evidence of congestion and edema in the lungs. The patient’s hematocrit was 37%, and his WBC count was 11,200/mm3. Blood urea nitrogen was 48 mg/dL (normal is <20 mg/dL). Urinalysis results showed that the patient’s protein was 2+ (24-hour excretion was 0.8 g), specific gravity was 1.012, and moderate amounts of RBCs and WBCs were in the urine. Serum albumin was 4.1 g/dL (normal is 3.5–4.5).

1. Which evidence supports the conclusion that this patient has a kidney disease? What is a probable cause of his kidney disease?
2. Which clinical pattern of kidney disease does this patient have? Explain the symptoms.
3. Which morphologic changes would you expect in the kidney?
4. What is the prognosis? What are the possible short- and long-term complications of this disease? Is it necessary to hospitalize the patient?

Answer 34

1. He most likely had an undiagnosed and untreated streptococcal pharyngitis and is now demonstrating evidence of an acute postinfectious glomerulonephritis.
2. Up to 50% of patients with acute poststreptococcal glomerulonephritis can be asymptomatic or have mild hematuria. The manifestation of symptoms usually occurs 1–2 weeks after an infection with group A beta-hemolytic streptococcal throat infection. He has generalized edema and signs of fluid overload (crackles and congestion on chest X-ray). He has hematuria and hypertension. Proteinuria is present but is not in the nephrotic range.
3. In acute postinfectious glomerulonephritis, immune complexes form that are composed of the antigenic organism (i.e., streptococcus) with IgG and C3 complement. The complexes activate the immune system, resulting in proliferation of cells (e.g., leukocytes, RBCs, and plasma proteins) in the endothelial and mesangial cells, rendering the capillary membrane permeable.
4. The prognosis is good, and recovery is usually rapid with resolution of the infection. Dialysis may be necessary for acute renal failure. Hospitalization may be necessary for close monitoring and treatment. Although not common, late renal complications can occur with progressive renal dysfunction.

Question 35

Chromosome affected in Wilm’s Tumor

Answer 35

chromosome 11

W11ms tumor

Question 36

Healthy urine is composed of water, sodium, uric acid, and
ammonia
protein
glucose
blood

Answer 36

ammonia

Question 37

in women, pregnancy may contribute to which type of incontinence?

Answer 37

stress

Question 38

A 37-year-old female patient presents to her PCP with complaints of incontinence. The patient describes that she notices the urine leaking most when sneezing or laughing. This patient is 7 months postpartum with no other significant medical history. The APRN knows that this is consistent with which type of incontinence?
A. Overflow
B. Urge
C. Stress
D. Mixed

Answer 38

C. Stress

Question 39

An APRN is educating a patient on strategies to prevent UTIs. All of the following are prevention strategies except:
A. Not delaying urination
B. Decreasing hydration
C. Wearing cotton underwear
D. Taking probiotics

Answer 39

B. Decreasing hydration

Question 41

Nocturnal incontinence in children is synonymous with:
A. Neurogenic Bladder
B. Areflexia
C. Cauda Equina Syndrome
D. Enuresis

Answer 41

D. Enuresis

Question 42

The kidneys synthesize this hormone that increases red blood cell production in the bone marrow:
A. Aldosterone
B. Erythropoietin
C. Parathyroid Hormone
D. 1alphahydroxylase

Answer 42

B. Erythropoietin

Question 43

This part of the nephron is responsible for the reabsorption of sodium, water, and bicarb and the secretion of potassium, hydrogen, urea, and ammonia
Glomerulus
Proximal Convoluted Tubule
Loop of Helene
Distal Convoluted Tubule

Answer 43

Distal Convoluted Tubule