Deck 7: Urology and Nephrology

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?

A) Acetaminophen suppository
B) BLS transport without intervention
C) Furosemide
D) Intravenous fluid therapy with normal saline

Answer 1

Intravenous fluid therapy with normal saline

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:

A) IV fluid therapy.
B) fentanyl.
C) Lasix IV.
D) morphine.

Answer 2

Lasix IV.

Question 3

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

A) The presence of estrogen in the lining of the female reproductive tract makes the mucous membranes more prone to infection.
B) Bacteria from the vagina commonly enter the female urethra.
C) The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract.
D) Males have more acidic urine, which is effective in eliminating bacteria from the urinary tract.

Answer 3

The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract.

Question 4

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

A) Pneumonia
B) Urethral obstruction
C) Interstitial nephritis
D) Heart failure with hypotension

Question 5

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

A) bleeding from the needle puncture site.
B) dysfunction of the fistula.
C) air embolism.
D) localized infection at the needle puncture site.

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?

A) Increased GFR results in retention of water, electrolytes, and metabolic waste.
B) Na⁺ and K⁺ excretion results in diuresis and dehydration.
C) Decreased GFR results in retention of water, electrolytes, and metabolic waste.
D) H⁺ excretion results in diuresis and alkalosis.

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?

A) 1,000 mL fluid bolus
B) 250 mL fluid bolus
C) IV of NS at a keep-open rate
D) Dopamine infusion

Question 8

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

A) cystitis.
B) cholecystitis.
C) prostatitis.
D) pyelonephritis.

Question 9

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

A) Blood glucose decreases.
B) H+ excretion leads to alkalosis.
C) Polycythemia occurs.
D) Urea and creatinine levels increase.

Question 10

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

A) Acute myocardial infarction
B) Hyperglycemia
C) Hypotension
D) Accumulated blood urea

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:

A) inability to urinate.
B) purulent urethral discharge.
C) fever.
D) painful urination.

Question 12

Tenderness associated with pyelonephritis is best evaluated by percussing:

A) in the midline, just superior to the symphysis pubis.
B) just lateral to the spine slightly superior to the sacroiliac joint.
C) laterally, just superior to the superior iliac crest.
D) over the pubis in lower UTI and at the flank in upper UTI.

Question 13

Which of the following statements about hemodialysis is TRUE?

A) Blood is removed from the body, wastes are collected in a filter, and blood is then returned to the body.
B) Dialysate is placed in the abdominal cavity, the peritoneum acts as a dialysis membrane, and dialysate is then removed from the abdominal cavity.
C) Dialysate enters the circulation through the venous site of a fistula and leaves through the arterial side of the fistula.
D) Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side.

Question 14

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

A) Vagina, bladder, urethra
B) Bladder, ureters, vagina
C) Urethra, bladder, kidney
D) Kidney, bladder, fallopian tubes

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:

A) oxygen, IV fluids, morphine.
B) Expedite transport in position of comfort.
C) oxygen, IV fluids.
D) IV fluids, morphine.

Question 16

Which of the following findings is most suggestive of cystitis?

A) Abdominal distension
B) Suprapubic tenderness to palpation
C) Flank pain radiating to the groin
D) Diffuse, periumbilical abdominal pain

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?

A) Water may move freely in both directions, but there will be no net movement of water.
B) Net movement of water from side B to side A will occur.
C) Net movement of water from side A to side B will occur.
D) Water will not move in either direction.

Question 18

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

A) Prior history of renal calculi
B) Lack of sexual activity
C) Urinary stasis
D) Male gender

Question 19

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

A) Excretion of glucose
B) Secretion of erythropoietin
C) Excretion of wastes
D) Regulation of water and electrolyte balance and pH

Question 20

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

A) IV normal saline.
B) dialysis.
C) furosemide.
D) potassium.

Question 21

Your patient has a history of benign prostatic hypertrophy. Which of the following complaints is most consistent with this history?

A) "It seems like I urinate a gallon at a time."
B) "My urine is cloudy and has a strong odor."
C) "I can't seem to urinate."
D) "I have blood in my urine first thing in the morning."

Question 22

Oxygen can benefit patients with chronic renal failure because it is common for patients with chronic renal failure to be:

A) anemic due to the blood loss associated with hemodialysis.
B) anemic due to decreased production of RBCs.
C) hypoxic secondary to associated congestive heart failure.
D) hypoxic secondary to associated hypotension.

Question 23

You are called to a local physician's office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient's wife brought him in because he has had a "chest cold," missed dialysis yesterday, and is now "acting strangely." Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO₂ = 97%, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep-open rate, which of the following is most appropriate for this patient in the prehospital setting?

A) IV sodium bicarbonate, 1 mEq/kg
B) IV magnesium sulfate, 10 gm
C) IV dextrose, 25 gm
D) IV furosemide, 120 mg

Question 24

Which of the following is a prerenal cause of acute renal failure?

A) Pyelonephritis
B) Embolism of the renal vein
C) Urethral obstruction due to renal calculi
D) Massive overdose of ibuprofen

Question 25

Which of the following best describes the mechanism of action of ACE inhibitors?

A) They inhibit sodium reabsorption, causing increased excretion of sodium.
B) They increase the GFR directly.
C) They inhibit the conversion of angiotensin I to angiotensin II.
D) They inhibit the formation of renin in the renin-angiotensin system.

Question 26

A 40-year-old female presents with hemorrhage from her dialysis graft. She states that she just got back from dialysis when the bleeding started. There is a significant amount of blood on the chair and floor. To control the bleeding, you would immediately:

A) place a tourniquet proximal to the graft.
B) place a tourniquet distal to the graft.
C) apply direct pressure over the graft.
D) apply ice to the area and elevate the extremity.

Question 27

Which of the following is associated with CAPD?

A) Catheter placed in the central circulation
B) Catheter providing access to the abdominal cavity
C) Dialysis shunt in either arm
D) Dialysis fistula in either arm

Question 28

Your patient is a 68-year-old female who is conscious but confused and lying supine in bed without complaint. Her daughter states that the patient was recently diagnosed with a bladder infection and has been taking antibiotics. She also states that her mother has not produced urine for two days, during which she has become increasingly confused. Physical examination reveals swelling to the face, hands, and feet; cool and moist skin; and lung sounds that are clear and equal bilaterally. HR = 104, BP = 142/88, RR = 14, SaO₂ = 96%. In addition to administering oxygen and monitoring the cardiac rhythm, which of the following courses of action is most appropriate?

A) IV of NS with 250 cc fluid challenge
B) 12-lead ECG, IV of NS KVO
C) IV of NS KVO, furosemide, 40 mg
D) IV of NS KVO

Question 29

When assessing a fistula used for hemodialysis, which of the following should concern you?

A) Pulsation with each heartbeat
B) A bruit on auscultation
C) Bruising around the fistula
D) Lack of a palpable vibration

Question 30

Which of the following chemistry findings would suggest acute renal failure?

A) Elevated blood urea nitrogen (BUN)
B) Decreased creatinine
C) Decreased potassium
D) Elevated iron

Question 31

Which of the following statements regarding a dialysis fistula is TRUE?

A) A fistula is a surgical anastomosis of an artery and a vein.
B) The fistula is the preferred site of venous access in an emergency situation.
C) A fistula uses a dual lumen tube to connect an artery and a vein.
D) The fistula is inserted peripherally, but the end of it is placed near the right atrium.

Question 32

Ammonia is converted into urea, to be excreted as urine, in which organ?

A) Kidney
B) Liver
C) Spleen
D) Bladder

Question 33

In order for hemodialysis to be effective in ridding the body of excess electrolytes, which of the following statements must be TRUE?

A) The dialysate must contain electrolytes in the same concentration as in the patient's blood.
B) The dialysate must contain electrolytes in a concentration lower than in the patient's blood.
C) The dialysate must contain electrolytes in a concentration higher than in the patient's blood.
D) The dialysate must not contain electrolytes.

Question 34

All of the following symptoms are consistent with urinary tract infection EXCEPT:

A) passing hard, granular material in the urine.
B) difficulty beginning and continuing to void.
C) tenderness over one or both flanks.
D) frequent urge to urinate.

Question 35

Which of the following would interfere with urine production?

A) Benign prostatic hypertrophy
B) Renal calculi
C) Tumor in the renal pelvis
D) Toxic damage to the nephrons

Question 36

Your patient is a 35-year-old male whom you suspect of having a kidney stone. All of the following would be consistent with this impression EXCEPT:

A) hematuria.
B) a description of "knifelike" pain.
C) restlessness.
D) fever.

Question 37

Which of the following statements about chronic renal failure (CRF) is accurate?

A) CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable.
B) The only treatment for CRF is a kidney transplant.
C) CRF is reversible if the cause is found and treated.
D) Hemodialysis can reverse CRF, but CAPD cannot.

Question 38

Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located?

A) Flank
B) Testes
C) Suprapubic region
D) Lower left or right quadrant, depending on which side is affected

Question 39

On-scene you are presented with a confused patient suffering from altered mental status. Additionally, in front of the family, the patient is very irritable and verbally abusive toward all present, including EMS. His wife states that his "kidneys are no good" and he also has "sugar" problems. Your assessment indicates that he is dyspneic with pale skin that is covered with a fine white sediment. His radial pulse is weak, rapid, and irregular. Additionally, you note edema to his hands, feet, and face. Crackles are noted to the lungs bilaterally and he has a dialysis graft on his right forearm. Your partner reports that his heart rate is 164, respirations 26, blood pressure 176/90, and SpO₂ 89%. After applying high-concentration oxygen, which of the following would you perform next?

A) Administer furosemide, 120 mg
B) Infuse a 1000 mL bolus of NS
C) Determine the blood glucose level
D) Administer sodium bicarbonate, 50 mEq

Question 40

The leading cause(s) of end-stage renal failure is (are):

A) renal calculi and kidney infection.
B) acute renal failure.
C) uncontrolled diabetes mellitus and hypertension.
D) kidney infection.

Question 41

You respond to a nursing home for an ill patient. Upon your arrival, the staff tells you that over the past few days the patient's urine output has been steadily declining. Today, the patient has voided only approximately 400 mL. You suspect:

A) chronic renal failure.
B) acute renal failure.
C) renal calculi.
D) pyelonephritis.

Question 42

When dealing with a possible renal emergency, it is imperative to ask:

A) "How many times have you urinated today?"
B) "How much do you weigh?"
C) "Do you think you can walk?"
D) "When was the last time you saw your nephrologist?"

Question 43

Glucose is excreted through the urea above which level?

A) 250 mg/dL
B) 500 mg/dL
C) 150 mg/dL
D) 180 mg/dL

Question 44

Acute renal failure occurs when a patient loses ________ of the functioning nephrons.

A) 80%
B) 70%
C) 60%
D) 50%

Question 45

Oliguria is defined as:

A) urine output of less than 400-500 mL daily.
B) urine output of less than 4000-5000 mL daily.
C) urine output of less than 100-200 mL daily.
D) urine output of less than 1000-2000 mL daily.

Question 46

The two main functions of the renal system are:

A) maintaining pH balance and blood volume.
B) maintaining blood glucose and clearing dead blood cells.
C) maintaining blood volume with proper pH, and retaining glucose and excreting urea.
D) maintaining hematocrit levels with the proper creatine balance, and activation of the RAAS.

Question 47

You respond to an ill patient. You note that the patient appears jaundiced and has a white frosty dust on his skin. You suspect:

A) eczema.
B) scabies.
C) uremic frost.
D) renal frost.

Question 48

You respond to a call of an ill male patient. Upon arrival, you see a patient in a chair, hooked into two large bags-one on an IV stand, one below his waist. The tubes are going into the patient's abdomen. You should suspect that this patient is undergoing:

A) peritoneal dialysis.
B) hemodialysis.
C) gastric lavage.
D) J tube feeding.

Question 49

You respond to a call of a patient experiencing back pain. Upon your arrival, the patient is curled into the fetal position and feels warm to the touch. You suspect:

A) acute renal failure.
B) acute renal calculi.
C) acute pyelonephritis.
D) acute urinary tract infection.