Question 1. A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8-day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early?
One of the infant’s kidneys may have failed to develop to a normal size.
The kidneys may be misshapen and have cysts.
The upper or lower poles of the two kidneys may be fused.
Renal cell carcinoma may be present.
Question 2. A 55-year-old man has made an appointment to see his nurse practitioner because he has been awakening three to four times nightly to void and often has a sudden need to void with little warning during the day. What is the man’s most likely diagnosis and possible underlying pathophysiologic problem?
Stress incontinence due to damage to CNS inhibitory pathways
Overactive bladder that may result from both neurogenic and myogenic sources
Overactive bladder due to intravesical pressure exceeding urethral pressure
Overflow incontinence that can result from displacement of the angle between the bladder and the posterior proximal urethra
Question 3. Which of the following individuals are displaying identified risk factors for the development of lower urinary tract obstruction?
A 32-year-old woman who had a healthy delivery of her third child 4 months ago
A 68-year-old man who has been diagnosed with benign prostatic hyperplasia (BPH)
A 55-year-old man with diabetes who is receiving diuretic medications for the treatment of hypertension
A 30-year-old woman who has been diagnosed with gonorrhea
A 74-year-old woman who has developed a lower bowel obstruction following several weeks of chronic constipation
A 20-year-old man who has spina bifida and consequent impaired mobility
Question 4. Which of the following individuals would be considered to be at risk for the development of edema?
An 81-year-old man with right-sided heart failure and hypothyroidism
A 60-year-old obese female with a diagnosis of poorly controlled diabetes mellitus
A 34-year-old industrial worker who has suffered extensive burns in a job-related accident
A 77-year-old woman who has an active gastrointestinal bleed and consequent anemia
A 22-year-old female with hypoalbuminemia secondary to malnutrition and anorexia nervosa
Question 5. A 31-year-old patient with a diagnosis of end-stage liver failure has been admitted to the intensive care unit of a hospital. Arterial blood gas sampling indicates that the man has an acid-base imbalance. Which of the following situations is most likely to result in an inappropriate pH?
Conservation or formation of new HCO3– by the kidneys
Low albumin and plasma globulin levels
Transcompartmental exchange of H+ and potassium ions
Renal excretion of HCO3– in the presence of excess base
Question 6 A 14-year-old boy who appears to be intoxicated is brought to the emergency department by ambulance. The EMTs report that the boy has denied consuming anything out of the ordinary, but an open antifreeze container was found in the boy’s room. Which of the following is likely to be used to treat the patient’s symptoms?
Syrup of ipecac
Question 7. A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention?
Hypertrophy of the bladder muscle and increased bladder wall thickness
Decreased urine production and nitrogenous wasted excretion by the kidneys
Decompensation, bladder stretching, and high residual urine volume
Overflow incontinence and loss of contraction power
Question 8. A 34-year-old male patient has diagnoses of liver failure, ascites, and hepatic encephalopathy secondary to alcohol abuse. The patient’s family is questioning the care team about why his abdomen is so large even though he is undernourished and emaciated. Which of the following statements most accurately underlies the explanation that a member of the care team would provide to the family?
An inordinate amount of interstitial fluid is accumulating in the patient’s abdomen.
The transcellular component of the intracellular fluid compartment contains far more fluid than normal.
The normally small transcellular fluid compartment, or third space, is becoming enlarged.
Gravity-dependent plasma is accumulating in the patient’s peritoneal cavity.
Question 9. A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient’s most likely diagnosis?
Fluid volume excess
Question 10. An 82-year-old resident of a long-term care facility with a recent history of repeated urinary tract infections and restlessness is suspected of having urinary retention. Which of the following actions by the care team is most appropriate?
Uroflowmetry to determine to rate of the patient’s urine flow
Ultrasound bladder scanning to determine the residual volume of urine after voiding
Renal ultrasound aimed at identifying acute or chronic kidney disease
Urinalysis focusing on the presence or absence of microorganisms, blood, or white cells in the man’s urine
Question 11. A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces?
She is susceptible to isotonic fluid volume deficit and hypernatremia as a result of water losses.
She is prone to isotonic fluid volume excess due to impaired osmolality from sodium losses.
She could develop third-spacing edema as a result of plasma protein losses.
She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.
Question 12. A 51-year-old woman diagnosed with multiple sclerosis (MS) five months prior is distressed that she has had several recent episodes of urinary incontinence. She has asked her nurse practitioner why this is the case. Which of the following statements best captures the facts that would underlie the nurse’s response to the patient?
Neurologic diseases like MS often result in flaccid bladder dysfunction.
She may be unable to sense her bladder filling as a result of her MS.
Lesions of the basal ganglia or extrapyramidal tract associated with MS inhibit detrusor contraction.
Pathologic reductions in bladder volume brought on by MS necessitate frequent micturition.
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