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Pathophysiology The Biologic Basis for Disease 6th Edition Huether McCance Test Bank

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Pathophysiology The Biologic Basis for Disease 6th Edition Huether McCance Test Bank

ISBN-13: 978-0323065849

ISBN-10: 0323065848

 

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Pathophysiology The Biologic Basis for Disease 6th Edition Huether McCance Test Bank

ISBN-13: 978-0323065849

ISBN-10: 0323065848

 

 

 

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Free Nursing Test Questions:

McCance: Pathophysiology, 6th Edition

 

Chapter 37: Alterations of Renal and Urinary Tract Function in Children

 

Test Bank

 

TRUE/FALSE

 

  1. The number of nephrons in the kidneys increases from birth until puberty.

 

ANS:   F

All the nephrons are present at birth, and their number does not increase as the kidney grows and matures.

 

REF:    p. 1403

 

  1. Urine formation and excretion do not begin until the eighth month of gestation.

 

ANS:   F

Urine formation and excretion begin by the third month of gestation.

 

REF:    p. 1403

 

  1. The total electrolyte concentration in extracellular fluids is greater in the newborn than in the adult.

 

ANS:   T

The total electrolyte concentration in extracellular fluids is greater in the newborn than in the adult.

 

REF:    p. 1404

 

  1. Approximately one third of individuals with horseshoe kidneys are asymptomatic.

 

ANS:   T

Approximately one third of individuals with horseshoe kidneys are asymptomatic, and the most common problems are hydronephrosis, infection, and stone formation.

 

REF:    p. 1404

 

  1. Chordee is a congenital defect of the genitourinary tract that results in a ventral curvature of the penis.

 

ANS:   T

In chordee a shortage of skin on the ventral surface causes the penis to bend or to “bow” ventrally (Figure 37-3).

 

REF:    p. 1405

 

  1. Epispadias may only be found in males.

 

ANS:   F

The incidence of exstrophy of the bladder is about 1 in 400,000 live births. Boys are predominant by a ratio of 5:1.

 

REF:    p. 1405

 

  1. Structural anomalies that are associated with urinary tract malformations include low-set, malformed ears; absent abdominal muscles; and imperforate anus or genital deviation.

 

ANS:   T

The following structural anomalies are commonly associated with urinary tract malformations:

  • Low-set, malformed ears
  • Chromosomal disorders, especially trisomy 13 (Patau syndrome) and trisomy 18
  • Absent abdominal muscles (prune-belly syndrome)
  • Anomalies of the spinal cord and lower extremities
  • Imperforate anus or genital deviation
  • Wilms tumor
  • Congenital ascites
  • Cystic disease of the liver
  • Positive family history of renal disease (hereditary nephritis or cystic disease)

 

REF:    p. 1404

 

  1. Unilateral renal agenesis is the total lack of one kidney and happens more often on the left side and in males.

 

ANS:   T

With unilateral renal agenesis, males are more often affected, and it is usually the left kidney that is absent.

 

REF:    p. 1407

 

  1. Hemolytic-uremic syndrome frequently causes acute renal failure in young children.

 

ANS:   T

Hemolytic uremic syndrome (HUS) is an acute disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia and is the most common cause of acute renal failure in young children.

 

REF:    p. 1408

 

  1. Organic causes of enuresis are the most common.

 

ANS:   F

Organic causes of enuresis account for 2% to 10% of cases.

 

REF:    p. 1415

 

MULTIPLE CHOICE

 

  1. Which of the following represents the final stage in the embryonic development of the kidney?
a. Metanephros
b. Mesonephros
c. Pronephros
d. Endonephros

 

 

ANS:   A

The metanephros, the permanent kidney, arises distal to the bifurcation of the aorta and develops from two different sources.

 

REF:    p. 1403; Table 37-1

 

  1. Urine formation and excretion begin at:
a. birth.
b. the third month of gestation.
c. the sixth month of gestation.
d. the ninth month of gestation.

 

 

ANS:   B

Urine formation and excretion begin by the third month of gestation.

 

REF:    p. 1403

 

  1. Which statement is false about why infants have a narrow chemical safety margin?
a. The immaturity of tubules may diminish the response to antidiuretic hormone (ADH).
b. An immature tubular transport capacity impairs the excretion of potassium.
c. An immature tubular transport capacity impairs the reabsorption of bicarbonate or buffer hydrogen with ammonia.
d. The immaturity of tubules may diminish the response to aldosterone.

 

 

ANS:   D

Because of a high hydrogen ion concentration, limited ability to regulate the internal environment, and lowered osmotic pressure, the infant’s renal system has a narrow chemical safety margin. The immaturity and smaller surface area of the tubules also may diminish the water reabsorption response to antidiuretic hormone (ADH). An immature tubular transport capacity means that the ability to excrete a potassium load, reabsorb bicarbonate, or buffer hydrogen with ammonia does not become efficient until approximately 2 years of age.

 

REF:    p. 1404

 

  1. The excretion of urea is low in infants because they have:
a. medullary nephrons with comparatively shorter loops at this stage of development.
b. immature tubular transport capacity, which impairs the excretion of urea.
c. a high anabolic state and use their protein for growth.
d. dilute urine due to the immaturity of their glomeruli.

 

 

ANS:   C

Urea excretion is low primarily because infants are in a high anabolic state and use their protein for growth.

 

REF:    p. 1404

 

  1. The adult takes in and excretes 2000 ml/day (representing approximately 5% of the total body fluid), whereas the infant takes in and excretes 700 ml/day (representing ____% of the total body fluid).
a. 10
b. 90
c. 190
d. 290

 

 

ANS:   D

In contrast, the infant’s daily exchange of 600 to 700 ml represents 290% of the total or nearly 50% of the extracellular volume.

 

REF:    p. 1404

 

  1. Which statement is false about how hypospadias develops? Hypospadias results from:
a. a disruption in male hormones, including testosterone.
b. a mutation of gene HP-1 (chromosome 16).
c. 5a reductase mutations.
d. hormones administered for in vitro fertilization.

 

 

ANS:   B

The etiology is multifactorial and related to disruptions in male hormones, including testosterone biosynthesis defects, 5a-reductase mutations, hormones administered for in vitro fertilization, advanced maternal age, and other environmental factors.

 

REF:    p. 1405

 

  1. On examination of a male child, it is determined that the urethral meatus is located on the undersurface of the penis. This condition is called:
a. hypospadias.
b. epispadias.
c. hyperspadias.
d. chordee.

 

 

ANS:   A

Hypospadias is a congenital condition in which the urethral meatus is located on the ventral side or undersurface of the penis.

 

REF:    p. 1404

 

  1. What initiates inflammation in acute poststreptococcal glomerulonephritis (PSGN)?
a. Lysosomal enzymes
b. Endotoxins from the streptococcus
c. Immune complexes
d. Immunoglobulin E (IgE) mediated response

 

 

ANS:   C

Antigen-antibody complexes are deposited in the glomerulus or the antigen may be trapped within the glomerulus and immune complexes formed in situ. The immune complexes initiate inflammation and glomerular injury.

 

REF:    p. 1407

 

  1. Which cells of the inflammatory process are NOT found in acute poststreptococcal glomerulonephritis (PSGN)?
a. Immunoglobulin G (IgG)
b. Immunoglobulin A (IgA)
c. Complement C3
d. Immunoglobulin E (IgE)

 

 

ANS:   D

Antigen-antibody complexes of immunoglobulin G (IgG), IgA, and C3 complement are deposited in the glomerulus or the antigen may be trapped within the glomerulus and immune complexes formed in situ.

 

REF:    p. 1407

 

  1. Hypertension occurs in acute poststreptococcal glomerulonephritis (PSGN) because of the:
a. increase in capillary permeability along the glomerular vascular membrane.
b. release of endothelin-1 as a result of endothelial injury and platelet activation.
c. activation of the renin-angiotensin-aldosterone system stimulated by decreased renal perfusion.
d. stimulation of b-adrenergic nerves that cause vasoconstriction.

 

 

ANS:   B

Hypertension occurs with increased blood volume and release of endothelin-1, a potent vasoconstrictor.

 

REF:    p. 1408

 

  1. The smoky, brown-colored urine in acute poststreptococcal glomerulonephritis (PSGN) is a result of the:
a. presence of red blood cells.
b. presence of urobilinogen.
c. slough from the collecting tubules.
d. protein that is in the urine.

 

 

ANS:   A

The urine is usually smoky brown or cola colored because of the presence of red blood cells.

 

REF:    p. 1408

 

  1. In immunoglobulin A (IgA) nephropathy (Berger nephropathy), the IgA, IgM, and complement proteins are deposited in the:
a. juxtamedullary nephrons.
b. glomerular endothelium.
c. mesangium of the glomerular capillaries.
d. parietal epithelium.

 

 

ANS:   C

It is characterized by deposition mainly of IgA, but also some IgM and complement proteins in the mesangium of the glomerular capillaries.

 

REF:    p. 1408

 

  1. The pathophysiologic process responsible for the hemolytic-uremic syndrome is that:
a. an autoimmune disorder in which immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen and remnants are excreted through the kidneys.
b. verotoxin from E. coli is absorbed from the intestines and damages erythrocytes and endothelial cells.
c. endotoxins from E. coli block the erythropoietin produced by the kidneys, which reduces the number of erythrocytes produced by the bone marrow.
d. failure of the nephron to filter urea increases the blood urea nitrogen, which binds to erythrocytes that are subsequently destroyed by the spleen.

 

 

ANS:   B

In HUS, verotoxin from E. coli is absorbed from the intestines, the glomerular arterioles become swollen and these narrowed vessels damage erythrocytes as they pass through. HUS is responsible for causing a cascade of effects including lysis of glomerular capillary endothelial cells.

 

REF:    pp. 1409-1410

 

  1. Which of the following is not considered part of the nephrotic syndrome in children?
a. Proteinuria
b. Pyuria
c. Hyperlipidemia
d. Edema

 

 

ANS:   B

Nephrotic syndrome is a term used to describe a symptom complex characterized by proteinuria, hypoproteinemia, hyperlipidemia, and edema.

 

REF:    p. 1409

 

  1. The first indication of nephrotic syndrome in children is:
a. periorbital edema.
b. scrotal or labial edema.
c. frothy urine.
d. ascites.

 

 

ANS:   A

Onset of nephritic syndrome is insidious, with periorbital edema as the first sign.

 

REF:    p. 1410

 

  1. Bacteria gain access to the urinary tract by:
a. the systemic blood that is filtered through the kidney.
b. traveling from the lymph adjacent to the bladder and kidneys.
c. ascending up the urethra into the bladder or up the ureters into the kidney.
d. colonizing the bladder when urine is static.

 

 

ANS:   C

UTIs in girls occur as a result of perineal bacteria, especially E. coli, ascending the urethra.

 

REF:    p. 1411

 

 

  1. Vesicoureteral reflux occurs in children because:
a. they do not ask for help in urinating in a timely manner and urine is forced up into the ureters.
b. the submucosal segment of the ureter is short, making the antireflux mechanism inefficient.
c. the trigone lying between the opening to the ureters and the urethra is underdeveloped.
d. as the bladder in infants and children fill, it pulls the smooth lining of the transitional epithelium away from the ureters so that the reflux valves are ineffective.

 

 

ANS:   B

Although reflux is considered abnormal at any age, the shortness of the submucosal segment of the ureter during infancy and childhood renders the antireflux mechanism relatively inefficient and delicate.

 

REF:    p. 1412

 

  1. What is the mechanism for development of Wilms tumor?
a. It involves tumor-suppressor genes.
b. It is an autosomal dominant inherited disorder.
c. It is an autoimmune disorder.
d. It is a congenital anomaly.

 

 

ANS:   A

The Wilms tumor suppressor gene (WT1) has been located at various chromosomal regions.  The deletion or inactivation of the WT1 gene accounts for about 5% to 10% of Wilms tumor cases.

 

REF:    p. 1413

 

  1. _____ is an anomaly often associated with Wilms tumor.
a. Renal anaplasia
b. Aniridia
c. Anemia
d. Hypothyroidism

 

 

ANS:   B

Approximately 10% of children who have Wilms tumor also have loss of other important genes and therefore have a number of congenital anomalies. These anomalies include aniridia (lack of an iris in the eye).

 

REF:    p. 1414

 

  1. Which statement is false about the causes of enuresis?
a. Enuresis is caused by a maturational lag.
b. Enuresis may be related to nonrapid eye movement (NREM) sleep.
c. Enuresis may be a symptom of obstructive sleep apnea.
d. Enuresis may be caused by excessive antidiuretic hormone (ADH).

 

 

ANS:   D

Children who remain dry usually have elevated levels of ADH and thus a decreased urine output at night which may be combined with reduced bladder capacity.

 

REF:    p. 1415

 

MATCHING

 

Match the kidney disorder with the corresponding descriptions.

a. Hemolytic-uremic syndrome
b. Henoch-Schönlein purpura nephritis
c. Renal dysplasia
d. Ureteropelvic junction obstruction
e. Polycystic kidney disease

 

 

  1. Associated with functional or organic obstruction of the collecting system

 

  1. Autosomal dominant inherited disorder

 

  1. Fibrin rich thrombi can be found throughout the microcirculation

 

  1. The most common cause of hydronephrosis in neonates

 

  1. IgA nephropathy causing inflammation to glomerular blood vessels

 

  1. ANS: C         REF:    p. 1406

NOT:   Renal dysplasia is associated also with a functional or organic obstruction of the collecting system.

 

 

 

  1. ANS: E          REF:    p. 1407

NOT:   Polycystic kidney disease is an autosomal dominant inherited disorder that occurs in about 1 in 1000 live births.

 

 

 

  1. ANS: A         REF:    p. 1409

NOT:   Hemolytic-uremic syndrome results in  fibrin-rich thrombi being found throughout the microcirculation.

 

 

 

  1. ANS: D         REF:    p. 1406

NOT:   Ureteropelvic junction obstruction is the most common cause of hydronephrosis in neonates.

 

 

 

  1. ANS: B         REF:    p. 1408

NOT:   Henoch-Schönlein purpura nephritis, also known as anaphylactoid purpura, is an IgA nephropathy that affects the glomerular blood vessels causing inflammation and damage to the vessel wall.

 

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