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UT Arlington NURS 5315 - Chapter 39 Exam

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Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 39: Alterations of Renal and Urinary Tract FunctionMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. How does progressive nephron injury affect angiotensin II activity?a. Angiotensin II activity is decreased.b. Angiotensin II activity is elevated.c. Angiotensin II activity is totally suppressed.d. Angiotensin II activity is not affected.ANS: BAngiotensin II activity is elevated with progressive nephron injury. Angiotensin II promotes glomerular hypertension and hyperfiltration caused by efferent arteriolar vasoconstriction and also promotes systemic hypertension. The chronically high intraglomerular pressure increases glomerular capillary permeability, contributing to proteinuria. Angiotensin II also may promote the activity of inflammatory cells and growth factors that participate in tubulointerstitial fibrosis and scarring.PTS: 1 DIF: Cognitive Level: Remembering 2. A patient has been diagnosed with a renal stone. Based on knowledge of common stone types, what self-care measure does the healthcare professional plan to teach the patient when stone analysis has returned?a. Increase water intake.b. Decrease soda intake.c. Restrict animal protein in the diet.d. Ingest 1000 mg of calcium a day.ANS: DCalcium stones (calcium phosphate or calcium oxalate) account for 70% to 80% of all stones requiring treatment. While all choices are appropriate for self-care in the patient with kidney stones, maintaining a calcium intake of 1000 to 1200 mg/day is a specific preventative measure for calcium stones.PTS: 1 DIF: Cognitive Level: Applying 3. The student asks the professor to explain the role of pyrophosphate, potassium citrate, and magnesium in the formation of kidney stones. What response by the professor is best?a. They inhibit crystal growth.b. They stimulate the supersaturation of salt.c. They facilitate the precipitation of salts.d. They enhance crystallization of salt crystals.ANS: AStone or crystal growth inhibiting substances, including potassium citrate, pyrophosphate, and magnesium, are capable of crystal growth inhibition. They do not stimulate supersaturation of salt, facilitate the precipitation of salts, or enhance crystallization of salts.PTS: 1 DIF: Cognitive Level: Understanding 4. Hypercalciuria is primarily attributable to which alteration?a. Defective renal calcium reabsorptionb. Intestinal hyperabsorption of dietary calciumc. Bone demineralization caused by prolonged immobilizationd. HyperparathyroidismANS: BHypercalciuria is usually attributable to intestinal hyperabsorption of dietary calcium and less commonly to a defect in renal calcium reabsorption. Hyperparathyroidism and bone demineralization associated with prolonged immobilization are also known to cause hypercalciuria but too a much lesser degree.PTS: 1 DIF: Cognitive Level: Remembering 5. Detrusor hyperreflexia develops from neurologic disorders that originate where?a. Spinal cord between C2 and C4b. Spinal cord between S2 and S4c. Above the pontine micturition centerd. Below the cauda equinaANS: CNeurologic disorders that develop above the pontine micturition center result in detrusor hyperreflexia, also known as an uninhibited or reflex bladder.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 6. A patient has overactive bladder syndrome. Which classification of drug does the healthcare professional plan to teach the patient about?a.β-Adrenergic blocking medicationsb. α-Adrenergic blocking medicationsc. Parasympathomimetic medicationsd. Anticholinesterase medicationsANS: BBecause the bladder neck consists of circular smooth muscle with adrenergic innervation, detrusor sphincter dyssynergia may be managed by α-adrenergic blocking (antimuscarinic) medications. The other medications would not be of benefit in this situation.PTS: 1 DIF: Cognitive Level: Remembering 7. Bladder cancer is associated with the gene mutation of which gene?a. c-erbB2b. Human epidermal growth factor receptor 2 (HER2)c. TP53d. mycANS: COncogenes of the ras gene family and tumor-suppressor genes including TP53 mutations and the inactivation of the retinoblastoma gene (pRb) are implicated in bladder cancer. The c-erbB2 gene is associated with breast cancer as is HER2. The myc gene codes for a transcription factor that plays a role in cellular life cycle events.PTS: 1 DIF: Cognitive Level: Remembering 8. A female patient has been diagnosed with an uncomplicated urinary tract infection. What self-care measure does the healthcare provider teach the patient that is specific to this type of infection?a. Drink at least eight glasses of water a day.b. Take medication if you have a fever.c. Rest as much as you can in the next few days.d. After using the bathroom, wipe from front to back.ANS: DThe most common infecting microorganisms are E. coli (80% to 85%) which is transmitted from the gut where it is a normal resident. Women should be taught to wipe from front to back after using the bathroom to avoid contamination of the urinary meatus with fecal material containing E. coli. The other options are appropriate for any type of infection.PTS: 1 DIF: Cognitive Level: Applying 9. A healthcare professional is assessing a patient who could have either pyelonephritis or cystitis. Which differentiating sign would assist the professional in making this diagnosis?a. Difficulty starting the stream of urineb. Spasmodic pain that radiates to the groinc. Increased glomerular filtration rated. Urinalysis confirmation of white blood cell castsANS: DClinical assessment alone is difficult to differentiate the symptoms of cystitis from those of pyelonephritis. Urine culture, urinalysis, and clinical signs and symptoms establish the specific diagnosis. When present, white blood cell casts indicate pyelonephritis. Difficulty starting the urine stream could indicate prostate enlargement. Neither disorder has spasmodic pain that radiates to the groin; this would be indicative of a kidney stone. Increased GFR would not be seen in an infectious disorder.PTS: 1 DIF: Cognitive Level: Applying 10. An 85-year-old person has a urinary tract infection. What clinical manifestation does the healthcare professional expect to see in this person?a. Confusion and poorly localized abdominal discomfortb. Dysuria, frequency, and suprapubic painc. Hematuria and flank paind.


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