Question 1

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?

Accepted Answer

The patient's fever, confusion, and combative behavior indicate a possible infection, which can be exacerbated by dehydration from the full Foley catheter bag. Intravenous fluid therapy with normal saline will help to flush out the urinary tract infection and improve the patient's hydration status. Acetaminophen suppository may help to decrease the fever, but it will not address the underlying infection. BLS transport without intervention is not appropriate given the patient's symptoms and condition. Furosemide is a diuretic medication used to treat fluid overload and is not indicated in this scenario.

Question 2

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:

Accepted Answer

Lasix (Furosemide) is a loop diuretic that is not appropriate for this patient with symptoms of renal colic. It could further exacerbate the pain and discomfort by increasing urine output and electrolyte imbalances. The appropriate treatment for renal colic typically includes IV fluid therapy to maintain hydration, pain management with medications such as fentanyl or morphine, and possibly antispasmodics to help relieve ureteral spasms.

Question 3

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

Accepted Answer

The female urethra is shorter than the male urethra, making it easier for bacteria to reach the bladder and cause infections.

Question 4

Which of the following is least likely to lead to acute renal failure?

Accepted Answer

Pneumonia is least likely to lead to acute renal failure as it does not directly affect the kidneys or the urinary tract. The other options can cause kidney damage and potentially lead to acute renal failure.

Question 5

All of the following are common complications of renal dialysis EXCEPT:

Accepted Answer

Air embolism is a rare but serious complication of renal dialysis. Bleeding, fistula dysfunction, and localized infection are all common issues that may occur during or after dialysis.

Question 6

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?

Accepted Answer

Acute interstitial nephritis is a condition characterized by inflammation and swelling in the interstitial tissue of the kidneys. This can lead to a decreased glomerular filtration rate (GFR), meaning that the kidneys are not able to filter waste products from the blood as efficiently. As a result, there is a retention of water, electrolytes, and metabolic waste in the body, leading to oliguria (decreased urine output) and edema (swelling) in various parts of the body. Altered mental status may occur due to impaired clearance of metabolic waste products. Therefore, choice C is the correct choice. A, B, and D are not accurate in describing the pathophysiology of acute interstitial nephritis.

Question 7

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?

Accepted Answer

The answer of Your patient is a 68-year-old male who...

Question 8

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

Accepted Answer

Cholecystitis is inflammation of the gallbladder and is not related to the urinary tract. The other three options--cystitis, prostatitis, and pyelonephritis--are all types of urinary tract infections.

Question 9

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

Accepted Answer

Chronic renal failure leads to a decrease in the glomerular filtration rate, resulting in a buildup of waste products such as urea and creatinine in the blood. Therefore, urea and creatinine levels increase in a patient with chronic renal failure. Blood glucose levels may be elevated in some cases of chronic renal failure due to insulin resistance, so A is false. H+ retention leads to acidosis, not alkalosis, so B is false. Polycythemia is not a typical finding in chronic renal failure, so C is false.

Question 10

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

Accepted Answer

During hemodialysis, patients with renal failure often have a buildup of blood urea that crosses the blood-brain barrier and causes neurological symptoms such as confusion, seizures, and coma. This is called uremic encephalopathy. Acute myocardial infarction, hyperglycemia, and hypotension may cause neurological symptoms, but they are not typically associated with hemodialysis.

Question 11

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:

Accepted Answer

The patient's symptoms are consistent with renal colic, which can cause pain to radiate from the flank to the groin. Painful urination is not typically associated with renal colic, while inability to urinate and purulent urethral discharge are more commonly associated with urinary tract infections or sexually transmitted infections. Fever can sometimes be present with renal colic, but it is not always present.

Question 12

Tenderness associated with pyelonephritis is best evaluated by percussing:

Accepted Answer

Tenderness associated with pyelonephritis is typically located in the flank area (in the back) and can be best evaluated by percussing at the flank. However, tenderness over the pubis may be present in lower UTI.

Question 13

Which of the following statements about hemodialysis is TRUE?

Accepted Answer

Hemodialysis relies on the principle of diffusion across a semipermeable membrane. Blood is removed from the body, circulated through a machine that filters out waste products and excess fluids, and then returned to the body. The dialyzer (filter) has a semipermeable membrane that separates the blood from the dialysate (fluid with a specific composition of electrolytes and other substances), which mimics the fluid that would normally be filtered by the kidney's nephrons. Therefore, choice D is the correct answer.

Question 14

What structures may be affected in a urinary tract infection in a female patient?

Accepted Answer

Urinary tract infections (UTIs) in females typically affect the urethra, bladder, and kidney. The ureters and fallopian tubes are less commonly affected. Therefore, answer option C (urethra, bladder, kidney) is the best choice.

Question 15

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:

Accepted Answer

This patient likely has a urinary tract infection and requires expedited transport to a medical facility for evaluation and treatment with antibiotics. Oxygen and IV fluids are not indicated based on the information provided, and morphine would not be appropriate for pain management in this case.

Question 16

Which of the following findings is most suggestive of cystitis?

Accepted Answer

Suprapubic tenderness is a common finding in cystitis, as the infection is localized to the urinary bladder. Abdominal distension, flank pain radiating to the groin, and diffuse, periumbilical abdominal pain are findings commonly associated with other conditions.

Question 17

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?

Accepted Answer

Water moves from areas of lower solute concentration to areas of higher solute concentration to achieve equilibrium when a membrane is permeable to water but not to solutes. Therefore, water will move from side B (25% dextrose) to side A (50% dextrose) to balance the concentration difference.

Question 18

Which of the following would most increase the likelihood of a urinary tract infection?

Accepted Answer

Urinary stasis, or the prolonged retention of urine in the bladder, can increase the likelihood of bacterial growth and infection. Other factors that may also increase the risk of urinary tract infections include prior history of UTIs, sexual activity, and female gender. Male gender is not typically associated with an increased risk of UTIs.

Question 19

In healthy individuals, which of the following is NOT a function of the kidney?

Accepted Answer

In healthy individuals, the kidneys do not excrete glucose. Instead, they reabsorb glucose and return it to the bloodstream. Excretion of glucose in the urine is a symptom of diabetes.

Question 20

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

Accepted Answer

Giving potassium during acute renal failure can be dangerous because the kidneys are not functioning properly and cannot properly excrete excess potassium, leading to potentially life-threatening hyperkalemia. Therefore, it is not used in the treatment of acute renal failure.

Quiz 7: Urology and Nephrology