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Exam 2 (MedSurg): Urinary Problems

Total questions: 100

Worksheet time: 52mins

Name
Class
Date
1.

Where does the adrenal gland lie in relation to the kidney?

a)

Below the kidney

b)

On top of the kidney

c)

Next to the kidney

d)

Inside the kidney

2.

The capsule of the kidney is a ________ membrane cover.

a)

fibrous

b)

mucous

c)

serous

d)

cartilaginous

3.

On the medial side of the kidney, what enters and exits?

a)

Arteries and nerves enter, veins and ureters exit

b)

Veins and nerves enter, arteries and ureters exit

c)

Only arteries enter

d)

Only veins exit

4.

What is the functional unit of the kidney?

a)

Nephron

b)

Glomerulus

c)

Tubule

d)

Capsule

5.

The renal artery arises from the ________.

a)

aorta

b)

inferior vena cava

c)

pulmonary artery

d)

hepatic vein

6.

Each renal artery divides into smaller branches, each forming an ________ arteriole.

a)

afferent

b)

efferent

c)

glomerular

d)

distal

7.

Afferent arteriole divides into a capillary network called the ________.

a)

glomerulus

b)

Bowman's capsule

c)

loop of Henle

d)

collecting duct

8.

Blood is filtered through hydrostatic pressure in which part of the kidney?

a)

Tubule

b)

Glomerulus

c)

Capsule

d)

Ureter

9.

What is the normal glomerular filtration rate (GFR)?

a)

125 mL/min

b)

80 mL/min

c)

200 mL/min

d)

50 mL/min

10.

What percentage of electrolytes is reabsorbed in the proximal convoluted tubule?

a)

50%

b)

80%

c)

100%

d)

20%

11.

Which part of the nephron is responsible for MOST of renal water reabsorption?

a)

Proximal convoluted tubule

b)

Loop of Henle

c)

Bowman's capsule

d)

Glomerulus

12.

What is the function of the descending loop of the nephron?

a)

Reabsorption of chloride and sodium

b)

Reabsorption of water, some sodium, urea, and other solutes

c)

Secretion of erythropoietin

d)

Regulation of blood pressure

13.

What is reabsorbed in the ascending loop of the nephron?

a)

Water

b)

Chloride and sodium

c)

Urea

d)

RBCs

14.

The ureters join the renal pelvis at the ________ junction.

a)

ureteropelvic

b)

ureterovesical

c)

pelvicalyceal

d)

cystoureteric

15.

The ureters join the bladder at the ________ junction.

a)

ureterovesical

b)

vesicoureteral

c)

ureteropelvic

d)

bladder-ureter

16.

Fill in the blank: The muscle of the bladder is called ________.

a)

detrusor

b)

sphincter

c)

pectoralis

d)

rectus

17.

What is the length of the female urethra?

a)

8-10 inches, 20-25 cm

b)

1-2 inches, 3-5 cm

c)

5-8 inches, 10-15 cm

d)

2-4 inches, 5-10 cm

18.

What is the length of the male urethra?

a)

1-2 inches, 3-5 cm

b)

8-10 inches, 20-25 cm

c)

5-8 inches, 10-15 cm

d)

2-4 inches, 5-10 cm

19.

Between ages 30 and 90, size and weight of kidneys decrease by what percentage?

a)

10-20%

b)

20-30%

c)

30-50%

d)

50-70%

20.

By the seventh decade, there is a loss of ________% glomerular function.

a)

30-50

b)

10-20

c)

50-70

d)

70-90

21.

Atherosclerosis accelerates the ________ of renal size with age.

a)

DECREASE

b)

INCREASE

c)

STABILIZATION

d)

ENLARGEMENT

22.

Fill in the blank: Decreased renal blood flow results in decreased ________.

a)

GFR

b)

urine glucose

c)

blood pressure

d)

serum sodium

23.

Physiologic changes in the urinary system include loss of ______ and muscle support.

a)

elasticity

b)

calcium

c)

glucose

d)

vitamin D

24.

During physical exam of the urinary system, which of the following is rarely palpable?

a)

Right kidney

b)

Left kidney

c)

Bladder

d)

Prostate

25.

Percussion during urinary system assessment may include a kidney punch to check for ______ tenderness.

a)

CVA

b)

hepatic

c)

splenic

d)

costal

26.

Fill in the blank: The bell should be placed at the _______ angle to listen for bruits in the kidneys during auscultation.

a)

costovertebral

b)

subcostal

c)

sternoclavicular

d)

iliac

27.

Fill in the blank: Urinalysis should ideally be performed on the _______ and examined within 1 hour.

a)

first void of the day

b)

second void of the day

c)

last void of the day

d)

it doesn't matter which void is used for specimen collection

28.

Fill in the blank: Creatinine clearance is measured by collecting a _______-hour urine specimen and closely approximates GFR.

a)

24

b)

12

c)

6

d)

48

29.

Which factors are involved in the stone formation of renal calculi?

a)

Metabolic, genetic, climate, lifestyle

b)

Occupational influences

c)

Urinary pH, solute load, inhibitors in urine

d)

All of the above

30.

Fill in the blank: Obstruction with urinary _______ is a factor in the pathophysiology of renal calculi.

a)

stasis

b)

infection

c)

pressure

d)

flow

31.

Fill in the blank: Types of calculi include calcium phosphate and calcium _______.

a)

oxalate

b)

carbonate

c)

sulfate

d)

chloride

32.

Which of the following is NOT a type of urinary tract calculus?

a)

Uric acid

b)

Cystine

c)

Struvite

d)

Glucose

33.

Fill in the blank: Struvite stones are composed of magnesium, ammonium, and _______.

a)

phosphate

b)

calcium

c)

sulfate

d)

oxalate

34.

What is the term used to describe the movement associated with severe pain due to kidney stones?

a)

Kidney stone dance

b)

Renal shuffle

c)

Stone agony walk

d)

Nephritic wriggle

35.

Which diagnostic study is used to assess for hematuria and crystalluria in patients with renal calculi?

a)

Noncontrast Spinal CT (CT/KUB)

b)

Ultrasound

c)

Complete urinalysis

d)

Intravenous Pyelography/IVP

36.

List two serum measurements that are important in the diagnosis of renal calculi.

a)

Serum calcium and serum uric acid

b)

Serum sodium and serum potassium

c)

Serum glucose and serum cholesterol

d)

Serum bilirubin and serum albumin

37.

Which medication is mentioned as a treatment for acute attacks of kidney STONES?

a)

Antibiotics

b)

Opioids

c)

Antihistamines

d)

Diuretics

38.

Which of the following is NOT a part of patient education for kidney stone prevention?

a)

Adequate hydration

b)

Dietary sodium restrictions

c)

Increased sugar intake

d)

Drugs to minimize stone formation

39.

What is the purpose of lithotripsy in the management of kidney stones?

a)

To break up stones into smaller fragments

b)

To dissolve stones chemically

c)

To remove stones surgically

d)

To prevent stone formation

40.

Select the following types of lithotripsy used to treat renal calculi:

a)

Laser lithotripsy

b)

Extracorporeal shockwave lithotripsy

c)

Percutaneous ultrasonic lithotripsy

d)

Electrohydraulic lithotripsy

e)

Subcostal pneumatic lithotripsy

41.

How much urine should be produced per day to ensure adequate fluid intake for prevention of renal calculi recurrence?

a)

Approximately 2L of urine per day

b)

Less than 500ml of urine per day

c)

About 500ml to 1L of urine per day

d)

More than 4L of urine per day

42.

Which of the following is part of education on management of acute episodes of renal calculi?

a)

Drug information

b)

Self-monitor urinary pH

c)

Pain management and comfort measures

d)

All of the above

43.

Straining all urine is recommended in the management of acute episodes of renal calculi.

a)

True

b)

False

44.

What is the most common bacterial infection in women?

a)

UTI

b)

Pneumonia

c)

Tuberculosis

d)

Renal Calculi

45.

At least ___% of women will develop a UTI in their lifetime.

a)

20%

b)

10%

c)

35%

d)

50%

46.

What is the term for colonizing bacteria in the bladder of healthy individuals that does not justify treatment?

a)

Symptomatic bacteriuria

b)

Asymptomatic bacteriuria

c)

Pyelonephritis

d)

Cystitis

47.

Which is the most common pathogen causing UTI?

a)

Staphylococcus aureus

b)

E. coli

c)

Klebsiella

d)

Pseudomonas

48.

E. coli can come from which of the following sources?

a)

Contaminated food

b)

Contact with animals

c)

Indwelling catheters

d)

All of the above

49.

Urine bacterial counts greater than or equal to ___ CFU (colony forming units)/mL indicate significant UTI.

a)

10510^5

b)

10310^3

c)

10210^2

d)

10410^4

50.

Urine bacterial counts as low as ___ CFU/mL with s/s are indicative of UTI.

a)

10210^2

b)

10310^3

c)

10410^4

d)

10510^5

51.

Which of the following are at-risk patients for UTIs?

a)

Immunosuppressed

b)

Diabetic

c)

Having undergone multiple antibiotic courses

d)

Have traveled to developing countries

e)

All of the above

52.

Upper urinary tract infection involves which organs?

a)

A) Kidneys, pelvis, and ureters

b)

B) Bladder and urethra

c)

C) Liver and pancreas

d)

D) Lungs and heart

53.

Lower urinary tract infection usually has which type of manifestations?

a)

Systemic

b)

No systemic

c)

Neurological

d)

Respiratory

54.

What are the two main types of urinary tract infections (UTIs)?

a)

Cystitis and urethritis

b)

Uncomplicated UTI and complicated UTI

c)

Acute and chronic UTI

d)

Bladder and kidney UTI

55.

Uncomplicated UTI usually involves only the _______.

a)

bladder

b)

kidney

c)

urethra

d)

ureter

56.

Which of the following is NOT a condition that coexists with complicated UTI?

a)

Obstruction, stones

b)

Catheters

c)

Diabetes, neurologic disease

d)

Hypertension

57.

The urinary tract above the urethra is sterile in healthy people.

a)

True

b)

False

58.

Which of the following is a defense mechanism that helps prevent UTIs?

a)

High urea concentration

b)

Low pH

c)

Decreased peristaltic activity

d)

Reduced glycoproteins

59.

Complete emptying of the _______ is a defense mechanism against UTIs.

a)

bladder

b)

stomach

c)

lung

d)

intestine

60.

SATA: Select the following factors that increase urinary stasis.

a)

benign prostate hypertrophy

b)

bladder tumor

c)

increased peristaltic activity

d)

neurogenic bladder

e)

abundant glycoproteins

61.

How are organisms most commonly introduced to cause UTIs?

a)

Via the ascending route from urethra and originate in the perineum

b)

Through the bloodstream from distant organs

c)

By direct inoculation during surgery

d)

Via lymphatic spread from adjacent tissues

62.

Which are less common routes for organisms to cause UTIs?

a)

Bloodstream, lymphatic system

b)

Ascending from urethra

c)

Direct extension from adjacent organs

d)

Descending from kidneys

63.

Gram negative bacilli normally found in the GI tract is a common cause of UTIs.

a)

True

b)

False

64.

What does urologic instrumentation allow bacteria to enter?

a)

Urethra and bladder

b)

Kidneys and liver

c)

Lungs and heart

d)

Stomach and intestines

65.

Kidney infection occurring from hematogenous transmission is always preceded by what?

a)

Injury to the tract

b)

Urinary retention

c)

Bladder stone formation

d)

Obstruction of the ureter

66.

Which of the following is NOT a consequence of kidney infection from hematogenous transmission?

a)

Obstruction of ureter

b)

Damage from stones

c)

Renal scars

d)

Increased urine production

67.

Which organism is often responsible for hospital-acquired UTIs?

a)

E. coli

b)

Staphylococcus aureus

c)

Pseudomonas aeruginosa

d)

Candida albicans

68.

Catheter acquired UTIs/CAUTIs are caused by bacteria biofilms developing on what?

a)

Inner surface of catheter

b)

Outer surface of bladder

c)

Tip of the needle

d)

Surface of urine bag

69.

In a patient with renal calculi, pain will slowly move to the lower quadrants of the abdomen as the stone nears the _______.

a)

ureterovesicular junction

b)

ureteropelvic junction

c)

loop of Henle

d)

glomerulus

70.

A patient is recovering from renal calculi. Which substance should the RN suggest the patient remove from their diet?

a)

sodium

b)

potassium

c)

purines

d)

nitrates

e)

tyramines

71.

SATA: Select all of the coexisting complications that may be present with a complicated UTI.

a)

indwelling catheters

b)

pregnancy

c)

renal calculi

d)

diabetes

e)

neurologic disease

72.

Urine pH is ______ as a defense mechanism against UTIs.

a)

alkaline

b)

acidic

c)

neutral

d)

high

73.

UTI symptoms are related to bladder ______ or bladder _______.

a)

degeneration, regeneration

b)

growth, shrinkage

c)

storing, emptying

d)

heating, cooling

74.

SATA: Select all of the UTI manifestations that relate to bladder STORAGE.

a)

urinating more than every 2 hours

b)

sudden strong desire to void immediately

c)

loss of urine during sleep

d)

difficulty starting urine stream

e)

constant interruption of the urine stream

75.

A UTI that presents with chills and fever is likely associated with infection of the ______ urinary tract.

a)

lower

b)

upper

c)

distal

d)

proximal

76.

In older adults, fever is MORE likely for both upper and lower tract UTIs.

a)

True

b)

Falase

77.

Typical signs and symptoms of UTIs are often ______ in older adults.

a)

enhanced

b)

absent

c)

more pronounced

d)

more painful

78.

SATA: Urine dipstick urinalysis can identify the presence of:

a)

nitrites

b)

white blood cells

c)

leukocyte esterase

d)

sodium

e)

potassium

79.

While a standard clean catch urine sample is good, a specimen obtained from ______ or suprapubic needle aspiration will yield the most accurate results.

a)

the purewick canister

b)

the bedpan

c)

the indwelling catheter

d)

the warm urinal sitting uncomfortably close to the patient's dinner tray

80.

How long will an antibiotic regimen be for a patient with uncomplicated cystitis?

a)

2-4 weeks

b)

30 minutes

c)

1-3 days

d)

4-7 days

81.

How long will an antibiotic regimen be for a patient with a complicated UTI?

a)

6-12 months

b)

2-4 weeks

c)

7-14 days

d)

10-12 weeks

82.

What is the purpose for using phenazopyridine (Pyridium) for UTIs?

a)

kills bacteria

b)

kills viruses

c)

soothes urinary tract mucosa

d)

blocks all nociceptive input to urinary tract

83.

When a patient is receiving phenazopyridine (Pyridium), what may happen to their urine?

a)

it becomes filled with blood

b)

it is stained bright blue

c)

it is stained deep orange

d)

it is stained dark green

e)

it becomes filled with large particulates

84.

When a patient defecates, how should they wipe to avoid contracting UTIs?

a)

Front to back

b)

Back to front

c)

Side to side

d)

Let it crust

85.

SATA: What are the MOST important things health care workers can do to avoid nosocomial UTIs?

a)

avoid external catheters at all costs

b)

avoid unnecessary indwelling catheterization

c)

avoid removing indwelling catheters prematurely

d)

wipe for patients whenever possible

e)

avoid using sterile gloves for indwelling catheter placement

86.

What do patients with indwelling catheters REQUIRE EVERY SHIFT to prevent UTIs?

a)

CHG baths and cleaning of catheter tubing

b)

Room temperatures of 80 degrees F or warmer

c)

EKG baths and cleaning of catheter tubing

d)

A new statlock

87.

What is a normal voiding pattern?

a)

Every 10 minutes

b)

Every 1-2 hours

c)

Every 3-4 hours

d)

Every 4-6 hours

e)

Twice daily

88.

Pyelonephritis is inflammation of the renal _______ caused by an infection.

a)

emphysema

b)

lower urinary tract

c)

parenchyma

d)

perineum

89.

A patient with untreated pyelonephritis can develop ______, which is life threatening.

a)

complicated UTI

b)

renal calculi

c)

CVA tenderness

d)

urosepsis

90.

What is vesicoureteral reflux?

a)

when urine moves backwards from the upper urinary tract to the lower urinary tract

b)

when urine moves backwards from the lower urinary tract to the upper urinary tract

c)

when urine moves backwards from the glomerulus to the bladder

d)

when urine moves backwards from the loop of Henle to the distal convoluted tubule

91.

SATA: Most manifestations of pyelonephritis can subside in a few days after onset, even without treatment. However _____ and ______ will remain if untreated.

a)

glycosuria

b)

pyuria

c)

polyuria

d)

bacteriuria

e)

ketonuria

92.

Patients with pyelonephritis will have a urine sample sent for cultures. If the HCP suspects bacteremia, _______ may also be ordered.

a)

BMP

b)

Type and Screen

c)

Blood Cultures

d)

Anti-Xa

93.

Once a patient with pyelonephritis is being treated with effective therapy, their symptoms will typically improve in _______ hours.

a)

1-2

b)

12-24

c)

48-72

d)

24-48

94.

Prompt treatment of cystitis is crucial to prevent ______ infections.

a)

bladder

b)

lower urinary tract

c)

upper urinary tract

d)

urethral

95.

Empiric antibiotic therapy means:

a)

infection is treated with a specific agent the pathogen has been confirmed to be sensitive to

b)

infection is treated with antibiotics only after cultures have come back from the lab

c)

infection is treated with broad spectrum antibiotics based on factors like site of infection, geographic location, and intensity of symptoms

d)

infection is treated with empirical narrow-spectrum macrolides as a first line treatment

96.

A noncontrast spinal CT scan is a preferred diagnostic imaging study for:

a)

lower urinary tract infection

b)

upper urinary tract infection

c)

renal calculi

d)

pyelonephritis

97.

SATA: Which clinical manifestations of UTIs are associated with bladder EMPTYING?

a)

weak stream

b)

urine loss after completion

c)

urinary retention

d)

nocturia

e)

strong desire to void immediately

98.

Patients with obesity are _____ likely to contract UTIs.

a)

more

b)

less

c)

not

99.

The RN should educate patients recovering from UTIs to always void after intercourse.

a)

True

b)

False

100.

Which type of pathogen is the MOST common cause of pyelonephritis?

a)

protozoa

b)

viruses

c)

bacteria

d)

fungi