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A)
B)
4.The anatomy class is learning about the countercurrent mechanism in the medullary
nephrons. What would the students learn about this mechanism and what it acts to do?
Promote sodium excretion
Concentrate or dilute the urine
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C)
D)
Ans:
5.The physiology instructor explains that the nephrons are fragile and require a constant
supply of blood and oxygen. What compensatory mechanisms work to maintain this
supply?
A)
The reninangiotensin system, causing vasoconstriction
B)
Baroreceptor monitoring of the renal artery
C)
Increased sweating when total water volume becomes too great
D)
Antidiuretic hormone (ADH) release in response to increased blood volume or
decreased osmolarity
Ans:
A
Feedback:
The reninangiotensin system causes vasoconstriction to improve blood flow to the
fragile nephrons. Baroreceptors are not found in the renal artery. Increased sweating is
not a reflex reaction to increased total body water. ADH is released in response to
decreased blood volume and increased osmolarity.
6.The nursing instructor is discussing anemia. The instructor explains about when a person
has chronic renal failure; how it leads to a decrease in the production of red blood cells
and so the person becomes anemic. This anemia is usually caused by a loss of what?
A)
Erythropoietin
B)
Hydrogen ions
C)
Renin
D)
Urea
Ans:
A
Feedback:
When nephrons are lost, as in renal failure, the juxtaglomerular cells that produce
erythropoietin are also lost leading to a decrease in red blood cell production and anemia.
Urea, renin, and hydrogen do not affect red blood cell production and are not associated
with anemia.
A)
B)
C)
7.As the physiology instructor explains to the students, the kidneys regulate calcium levels
within a very tight range by the activity of the parathyroid hormone (PTH) and calcitonin.
Where does the fine-tuning of the calcium level occur?
Bowman's capsule
The proximal convoluted tubule
The distal convoluted tubule
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D)
Ans:
8.A student asks the physiology instructor how the kidneys control body fluid composition.
The instructor explains that the kidneys, by actively removing solutes from the capillary
system for excretion in the urine, perform a process called what?
A)
Glomerular filtration
B)
Tubular reabsorption
C)
Tubular secretion
D)
Tubular metabolism
Ans:
C
Feedback:
Tubular secretion is the movement of solutes from the capillary bed into the renal tubule.
Glomerular filtration is the passing of fluid from the capillary system into the renal tubule
in Bowman's capsule. Tubular reabsorption is the movement of solutes from the tubule
into the capillary system.
9.The students are discussing the electrolytes in the body. What should the students know
has the greatest influence on potassium loss from the body?
A)
Aldosterone
B)
Antidiuretic hormone
C)
Renin
D)
Carbonic anhydrase
Ans:
A
Feedback:
Potassium concentration is regulated throughout the tubules with aldosterone being the
strongest influence for loss. Renin activates angiotensinogen, which becomes angiotensin
I. Antidiuretic hormone is produced by the hypothalamus and stored in the posterior
pituitary gland and is important in maintaining fluid balance. Carbonic anhydrase causes
sodium ions to be reabsorbed and allows carbon dioxide and water to combine to form
carbonic acid. This leads to the formation of sodium bicarbonate, which is stored in the
renal tubules as the body's reserve for use when the body needs a buffer against acid.
10.The students are studying the male reproductive system. The instructor tells the students
that in the male, the urethra leaves the urinary bladder and passes through what?
A)
Vas deferens
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B)
C)
D)
Ans:
Renal calyx
Prostate gland
Renal cortex
C
Feedback:
In the male, the urethra leaves the urinary bladder and passes through the prostate gland.
The renal calyx and cortex are located in the kidney and the urethra does not pass through
the kidney. The vas deferens delivers the sperm from the testicles to the urethra.
11.The nurse admits a patient with a high potassium level. The nurse recognizes this
activates the body's sodiumpotassium exchange leading to which physical symptom?
A)
Dehydration
B)
Water retention
C)
Fatigue
D)
Dizziness
Ans:
B
Feedback:
If potassium levels are very high, the retention of sodium in exchange for potassium also
leads to retention of water and a dilution of blood volume, which decreases potassium
concentration. Dehydration is a lack of volume in the blood vessels, which can lead to
dizziness. Fatigue is a symptom of anemia, which is associated with renal failure.
12.The nurse is caring for a patient suspected of having renal dysfunction. When reviewing
laboratory results for this patient, the nurse recalls that several substances are filtered
from the blood by the glomerulus and these substances are then excreted in the urine. The
nurse identifies the presence of which substances in the urine as abnormal findings?
A)
Potassium and sodium
B)
Bicarbonate and urea
C)
Blood cells and protein
D)
Creatinine and chloride
Ans:
C
Feedback:
The various substances normally filtered by the glomerulus, reabsorbed by the tubules,
and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea,
creatinine, and uric acid. Within the tubule, some of these substances are selectively
reabsorbed into the blood. Glucose scarring or swelling of or damage to the
semipermeable membrane leads to the escape of larger plasma components such as blood
cells or protein into the filtrate. A clinical sign of renal damage is the presence of blood
cells or protein in the urine.
13.The pathophysiology instructor is talking to the prenursing students about hypovolemia
and the kidneys. The instructor points out that when the blood pressure is low due to
dehydration, the body will compensate by secreting what?
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A)
B)
C)
D)
Ans:
Antidiuretic hormone
Aldosterone
Renin
Angiotensin
C
Feedback:
Regulation of blood pressure is also a function of the kidney. Specialized vessels of the
kidney called the vasa recta constantly monitor blood pressure as blood begins its passage
into the kidney. When the vasa recta detect a decrease in blood pressure, specialized
juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole
secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then
converted to angiotensin II, the most powerful vasoconstrictor known. The
vasoconstriction causes the blood pressure to increase. The cortex of the suprarenal gland
secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in
response to poor perfusion or increasing serum osmolality. The result is an increase in
blood pressure. When the vasa recta recognize the increase in blood pressure, renin
secretion stops. Failure of this feedback mechanism is one of the primary causes of
hypertension. Therefore, options A, B, and D are incorrect.
14.The nurse is aware that which area of the kidney provides quick response to any damage
or injury to the kidney cells?
A)
Juxtaglomerular apparatus
B)
Reninangiotensinaldosterone system
C)
Macula densa
D)
Countercurrent mechanism
Ans:
C
Feedback:
The macula densa consists of immune system cells and chemicals that can respond
quickly to any cellular damage or injury. The juxtaglomerular apparatus produce
erythropoietin and renin. The Reninangiotensinaldosterone system works to maintain
blood flow to the kidneys. The countercurrent mechanism works to concentrate and dilute
the urine.
15.A patient who has signs and symptoms of kidney failure has experienced what percentage
of loss of the nephrons in the kidneys?
A)
10%
B)
25%
C)
50%
D)
75%
Ans:
D
Feedback:
Only 25% of the total number of nephrons is necessary to maintain healthy renal function
so most patients must have experienced nephron loss of at least 75% to have signs and
symptoms of kidney failure. The other options are not correct.
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16.What function does the kidney perform to assist in maintaining acidbase balance within
the necessary normal range?
A)
Excrete acid in the lungs
B)
Return bicarbonate to the body's circulation
C)
Return acid to the body's circulation
D)
Excrete bicarbonate in the urine
Ans:
B
Feedback:
The kidney performs two major functions to assist in this balance. The first is to reabsorb
and return to the body's circulation any bicarbonate from the urinary filtrate; the second is
to excrete acid in the urine. Therefore, options A, C, and D are incorrect.
17.A student asks the physiology instructor how bicarbonate is replaced by the body when a
patient loses it from the body. What should the instructor answer?
A)
The renal tubules secrete new bicarbonate into the urine.
B)
The juxtaglomerular cells secrete new bicarbonate into the blood.
C)
The juxtaglomerular cells generate new bicarbonate.
D)
Renal tubular cells generate new bicarbonate.
Ans:
D
Feedback:
To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through
a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by
the tubules and returned to the body. This makes options A, B, and C incorrect.
18.A student asks the pathophysiology instructor what the function of renin is in the body.
What is the instructor's best response to the student's question?
A)
Renin is directly involved in the control of arterial blood pressure and it is
essential for proper functioning of the glomerulus.
B)
Renin is involved in venous blood pressure and controls the flow of blood through
the tubules.
C)
Renin is directly involved in the control of arterial blood pressure and the flow of
blood through the pyramids of the kidney.
D)
Renin is involved in venous blood pressure and it is essential for proper
functioning of the glomerulus.
Ans:
A
Feedback:
Renin is a hormone directly involved in the control of arterial blood pressure. It is
essential for proper functioning of the glomerulus. The other options are not correct.
19.A 78-year-old patient presents at the clinic complaining of urinary problems. The patient
tells the nurse that he experiences frequency, urgency, and has problems initiating and
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A)
B)
C)
D)
Ans:
maintaining a urinary stream. Based on the patient's age, what would the nurse suspect?
Enlarged prostate
Decreased bladder function
Increased kidney function
Partially obstructed ureter
A
Feedback:
The ureters, urinary bladder, and urethra make up the rest of the urinary tract. The longer
male urethra passes through the prostate gland, which may enlarge or become infected, a
problem often associated with advancing age. The patient's advancing age does not
increase the risk of decreased bladder function, increased kidney function, or partially
obstructed ureter.
20.A daughter is talking with the urologist who is caring for the woman's 78-year-old
mother. The mother has multiple sclerosis and has lost control of her bladder. The
daughter asks the urologist what made her mother become incontinent. What would be
the urologist's best answer?
A)
I don't know, but there are lots of medicines we can try to fix it.
B)
After control of the bladder is learned, you must have a functioning nervous
system to maintain it.
C)
Your mother's age has a lot to do with it.
D)
This happens sometimes and no one is quite sure why.
Ans:
B
Feedback:
Control of bladder emptying is learned control over the urethral sphincter. Once it is
established, a functioning nervous system is necessary to maintain control.
21.A young woman presents with signs and symptoms of a urinary tract infection (UTI).
What factor that has the most influence on this situation does the nurse know?
A)
The woman has a short urethra.
B)
The woman has multiple sexual partners.
C)
The woman takes too many bubble baths.
D)
The woman does not clean herself as she should.
Ans:
A
Feedback:
In the female, the urethra is a very short tube that leads from the bladder to an area
populated by normal bacterial flora including Escherichia coli, which can cause frequent
bladder infections or cystitis. Recurrent UTIs do not indicate the woman has multiple
sexual partners, takes too many bubble baths, or does not clean herself adequately.
22.The renal system has several major functions in the body. What are they? (Select all that
apply.)
A)
Acting as a diuretic for the body
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B)
C)
D)
E)
Ans:
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B)
C)
D)
Ans:
Magnesium
Chloride ions
Potassium ions
C
Feedback:
As sodium is actively moved out of the filtrate, it takes chloride ions and water with it.
Sodium does not take calcium, magnesium, or potassium ions with it.
26.Sodium ions are reabsorbed into the body by the aid of what catalyst?
A)
Aldosterone
B)
Sodium bicarbonate
C)
Angiotensin
D)
Carbonic anhydrase
Ans:
D
Feedback:
Carbonic anhydrase, an enzyme, speeds the process of carbon dioxide and water
combining to form carbonic acid. The carbonic acid immediately dissociates to form
sodium bicarbonate, using a sodium ion from the renal tubule and a free hydrogen ion (an
acid). The other options are not correct.
27.A student asks the physiology instructor where chloride is primarily reabsorbed. What
would be the instructor's best answer?
A)
The loop of Henle
B)
The nephron
C)
The kidney
D)
The distal convolute tubule
Ans:
A
Feedback:
Chloride is an important negatively charged ion that helps to maintain electrical neutrality
with the movement of cations across the cell membrane. Chloride is primarily reabsorbed
in the loop of Henle, where it promotes the movement of sodium out of the cell. The
other options are not correct.
28.The students are learning about maintaining electrolytes in the body by actions within the
kidney. Where do the students learn the fine-tuning of potassium levels occurs?
A)
Proximal convoluted tubule
B)
Distal convoluted tubule
C)
Loop of Henle
D)
Glomerulus
Ans:
B
Feedback:
The fine-tuning of potassium levels occurs in the distal convoluted tubule, where
aldosterone activates the sodiumpotassium exchange, leading to a loss of potassium.
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Page 10
A)
B)
C)
D)
E)
Ans:
33.A patient is being treated for dehydration and asks the nurse how the body maintains
proper fluid composition and volume. The nurse correctly includes which regulatory
mechanisms? (Select all that apply.)
A)
Concentration of urine
B)
Increased production of erythropoietin
C)
Secretion of electrolytes
D)
Dilution of urine
E)
Increased blood pressure
Ans:
A, C, D
Feedback:
The kidneys regulate the composition of body fluids by balancing the levels of the key
electrolytes, secreting or absorbing these electrolytes to maintain the desired levels. Body
fluid volume is controlled by diluting or concentrating urine. Erythropoietin helps to
increase red blood cell production, which helps increase oxygen to the organs. Increased
blood pressure does not change the volume or composition of body fluids.
34.The nursing instructor is explaining the function of natriuretic hormone in relation to
urine composition. The instructor shares that this hormone is released in response to
which conditions? (Select all that apply.)
A)
Fluid depletion
B)
Fluid overload
C)
Hemodilution
D)
Hemoconcentration
E)
Decreased red blood cell production
Ans:
B, C
Feedback:
Natriuretic hormone is released in response to fluid overload, not fluid depletion and
hemodilution, and not hemoconcentration. Erythropoietin is released in response to
decreased red blood cell production.
35.The nurse, who works in the emergency department, is aware that the reninangiotensin
aldosterone system works to maintain blood flow in the kidneys. What vital sign would
Page 11
A)
B)
C)
D)
Ans:
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