Section 8.

Renal Problems

MULTIPLE CHOICE

1. A patient is seen in the clinic with a chief complaint of hematuria. To make a differential
diagnosis, which of the following questions should be asked?
A. “Do you have a history of liver disease?”
B. “What medications are you currently taking?”
C. “Have you noticed swelling in your ankles?”
D. “Do you have an autoimmune condition?”
ANS: B PTS: 1

2. The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take
which of the following actions?
A. Repeat the test.
B. Refer to a nephrologist.
C. Measure the serum protein.
D. Obtain a blood urea nitrogen (BUN) and creatinine.
ANS: B PTS: 1

3. The clinician is speaking with Bernadette, who has recently been diagnosed with urinary
incontinence. She has had this condition for a number of years, she is 5 feet 5 inches, and she
weighs 140 pounds. Which of the following should the health-care provider be aware of?
A. It is uncommon that Bernadette has this condition because she is female.
B. Most patients should wait 3 months for follow-up after diagnosis.
C. Since Bernadette has a regular body mass index, she probably has a positive body
image.
D. Bernadette may be suffering from depression and may need a psychiatric consult.
ANS: D PTS: 1

4. A patient is seen in the clinic with hematuria confirmed on microscopic examination. The
clinician should inquire about the ingestion of which of these substances that might be the
cause of hematuria?
A. NSAIDs
B. Rhubarb
C. Vitamin A
D. Red meat
ANS: A PTS: 1

5. A 27-year-old female presents with a chief complaint of burning and pain on urination. She
has no previous history of urinary tract infection (UTI). What are some additional symptoms
consistent with a diagnosis of lower UTI?
A. Thick, green discharge
B. Fever, chills, costovertebral angle (CVA) tenderness
C. Blood in urine and frequency
D. Foul-smelling discharge, perineal itch
 ANS: C PTS: 1

6. Which of the following patients is most likely to have urge incontinence?

A. Mary, a 35-year-old female with a history of four vaginal deliveries
B. Devon, a 40-year-old male with a history of multiple sclerosis
C. Dan, a 67-year-old male with a history of diabetes mellitus
D. Cheryl, a 95-year-old female who takes Norpace daily
ANS: B PTS: 1

7. A 30-year-old patient presents with pain on urination. The urine microscopy of clean-catch
urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the
probable diagnosis?
A. Lower urinary-tract infection
B. Chlamydia infection
C. Candidiasis
D. Pyelonephritis
ANS: A PTS: 1

8. A patient presents with CVA tenderness and a several-day history of high fever, chills, and
dysuria. Which of the following diagnoses is most likely given the above information?
A. Pyelonephritis
B. Cystitis
C. Renal calculi
D. Bladder tumor
ANS: A PTS: 1

9. Which of the following information patients with a UTI can receive Bactrim DS?
A. Mary, a 25-year-old who is 25 weeks pregnant
B. Donna, a 55-year-old with an allergy to sulfa
C. Lisa, a 33-year-old who is breastfeeding her 3-week-old daughter
D. Tiffany, a 16-year-old with a hypersensitivity to penicillin
ANS: D PTS: 1

10. Which of the following Macrobid doses is appropriate to treat a lower UTI?
A. 200 mg bid  14 days
B. 100 mg bid  5 days
C. 500 mg daily  8 days
D. 800 mg daily  2 days

ANS: B PTS: 1

11. A patient is seen in the office complaining of severe flank pain and hematuria. The clinician
should assess this patient for which risk factor for poststreptococcal glomerulonephritis?
A. Hypertension
B. Constipation
C. Tubal ligation
D. Diabetes
 ANS: A PTS: 1

12. A patient is diagnosed with urge incontinence. Before prescribing Detrol LA, the provider
should question the patient about which of these contraindications to this medication?
A. Diarrhea
B. Parkinson’s disease
C. Closed-angle glaucoma
D. Breast cancer
ANS: C PTS: 1

13. A patient is diagnosed with overactive bladder. Which of the following instructions should be
given to this woman?
A. “Limit the amount of water that you drink.”
B. “Eliminate caffeine from your diet.”
C. “Wear panty liners.”
D. “You should not attempt pregnancy.”
ANS: B PTS: 1

14. A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy.
Which of the following actions should be taken next?
A. Send a urine specimen for microscopy and evaluate for fungal colonies.
B. Increase the dose of antibiotic.
C. Order a cystoscopy.
D. Order a different antibiotic.
ANS: A PTS: 1

15. Which of the following are predisposing factors for pyelonephritis?

A. Pregnancy
B. Dehydration
C. Smoking
D. Alkaline urine
ANS: A PTS: 1

16. Which of the following types of proteinuria is associated with Hodgkin’s disease?
A. Tamm-Horsfall proteinuria
B. Tubulointerstitial area involvement
C. Altered glomerular capillary permeability
D. Bence Jones proteinuria
ANS: D PTS: 1

17. When proteinuria is detected in a low-risk patient, which laboratory testing should be ordered
in addition to Bence Jones proteins?
A. Serum glucose
B. Lipid panel
C. Hemoglobinopathy
D. Cerebrospinal fluid (CSF) lumbar puncture
ANS: B PTS: 1
18. Jeremy is a 27-year-old who comes to the clinic complaining of red-tinged urine. The clinician
performs a urine dipstick and finds that the protein is 2+. Which of the following from
Jeremy’s history is related to this finding?
A. He is training for a marathon.
B. He recently broke a toe.
C. He began taking Lexapro 2 weeks ago.
D. He works in an office setting.
ANS: A PTS: 1

19. Which of the following is true regarding the cause of isolated hematuria?
A. It is usually caused by anemia.
B. It can be due to bleeding in the urethra.
C. It is can be due to hemoglobinopathies.
D. It is usually due to sickle cell disease.
ANS: B PTS: 1

20. Which of the following medications may be linked to dysuria?

A. Vitamin A
B. Mirena
C. Paxil
D. Gabapentin
ANS: C PTS: 1

21. A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria. She
is diagnosed with acute pyelonephritis. How should this patient be managed?
A. 3-day course of oral antibiotics
B. Hospitalization
C. Encourage cranberry juice intake
D. 6-week course of antibiotics
ANS: B PTS: 1

22. A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and
diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list
of differential diagnoses?
A. Pancreatitis
B. Urinary tract infection
C. Prostate tumor
D. Gastroesophageal reflux disease
ANS: A PTS: 1

23. Which of the following instructions should be given to the patient with nephrolithiasis?
A. Take ibuprofen, 600 mg every 8 hours.
B. Take Tums for stomach upset.
C. Drink more black tea.
D. Increase intake of vegetables, like spinach.
ANS: A PTS: 1
24. Which of the following patients is at risk for developing urinary-tract cancer?
A. The 45-year-old woman who is 10 lbs underweight
B. The 78-year-old man who smokes three packs of cigarettes a day
C. The 84-year-old man who worked in an office setting
D. The 25-year-old woman who has a lactose allergy
ANS: B PTS: 1

25. Which of the following medications will help reduce urinary excretion of nephrolithiasis-
forming substances?
A. Furosemide
B. Triamterene
C. Calcium supplement
D. Hydrochlorothiazide
ANS: D PTS: 1

26. Ryan has a UTI and has been prescribed Ceclor. Which of the following side effects should he
be made aware of?
A. Emesis
B. Abdominal discomfort if taken without food
C. Nausea
D. Flatulence
ANS: C PTS: 1

27. A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should
refer the patient to a nephrologist for which of these treatments?
A. Chemotherapy
B. Nephrectomy
C. Palliative treatment
D. Radiation
ANS: B PTS: 1

28. A patient has just had a total nephrectomy for renal cell carcinoma. Which of the following
follow-up strategies is appropriate?
A. Computed tomography (CT) scan of abdomen and renal fossa in 3 to 6 months
B. Magnetic resonance imaging (MRI) of abdomen and kidneys in 2 to 4 months
C. X-ray of abdomen and renal fossa in 6 to 8 months
D. No follow-up is necessary.
ANS: A PTS: 1

29. An 86-year-old woman is seen in the clinic for recurrent hematuria. The provider suspects
bladder cancer. Which of the following data from the history is considered a risk factor for
this type of cancer?
A. History of alcoholism
B. Sedentary lifestyle
C. Obesity
D. 65-year smoking history
 ANS: D PTS: 1

30. A 40-year-old woman presents to the clinic with complaints of dull and achy flank pain and
hematuria. She also notes, “I think I have a mass in my stomach.” She works in a chemical
plant and has a sedentary lifestyle. Which of the following parts of her history lead the
clinician to believe she may have renal cell carcinoma?
A. Age
B. Gender
C. Works in chemical plant
D. Sedentary lifestyle
ANS: C PTS: 1

31. Which of the following diagnostic tests should be ordered for a patient suspected of having
bladder cancer?
A. Kidneys, ureter, bladder x-ray
B. Cystoscopy with biopsy
C. Magnetic resonance imaging
D. Urine tumor marker (NMP22)
ANS: B PTS: 1

32. A 78-year-old man says he has been diagnosed with Stage 0 bladder cancer and asks the
provider what that means. Which is the best response?
A. “There is no such thing as Stage 0 cancer.”
B. “You have cancer that has spread to the surrounding tissue.”
C. “Your cancer has spread to other organs.”
D. “Your cancer must be cured by removing your bladder.”
ANS: C PTS: 1

33. Talia has bladder cancer that has grown into the fatty tissue surrounding the bladder and to her
vagina. The cancer has not spread to distant sites or lymph nodes. What is an appropriate
treatment option?
A. Palliative care only
B. External beam radiation therapy
C. Only chemotherapy is appropriate
D. Radical cystectomy and lymph node resection
ANS: D PTS: 1

34. The patient is diagnosed with acute renal failure (ARF). Which of the following data obtained
from the history should alert the provider that this is a case of prerenal azotemia?
A. Patient is on lisinopril
B. Nephrolithiasis
C. Recent infection where gentamicin was used in treatment
D. Ureteral obstruction
ANS: A PTS: 1

35. The patient is diagnosed with ARF. Which of the following conditions is the most common
cause?
 A. Renal calculi
B. Acute tubular necrosis
C. Cardiac failure
D. Acute glomerulonephritis
ANS: B PTS: 1

36. Danielle presents to the clinic, saying “I do not feel like I want to eat.” She also notes she is
experiencing lethargy, nausea, headache, and muscle cramps. She “did not go to the bathroom
a lot” yesterday. Which of the following stages of acute kidney injury (AKI) is Danielle in?
A. Initiating stage
B. Oliguric stage
C. Diuretic stage
D. Recovery stage
ANS: A PTS: 1

37. Which of the following physical examination manifestations are consistent with a patient in
ARF?
A. Weight gain
B. Glycosuria
C. Irritability
D. Hypotension
ANS: D PTS: 1

38. Laqueena has chronic kidney disease (CKD). Her glomerular filtration rate (GFR) is 33
mL/min per 1.73 m2 of body surface area. Which of the stages does her GFR fall under, as
defined by the Third National Health and Nutrition Examination Survey?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
ANS: C PTS: 1

39. Which of the following examination findings should be expected in a patient with CKD?
A. Weak, thready pulse
B. Auscultatory crackles
C. Hypotension
D. Pleural friction rub
ANS: B PTS: 1

40. Which of the following strategies is useful when managing hypertension in a patient with
CKD?
A. Keep HbA1c of less than 7.5%.
B. For a patient with proteinuria of more than 1 g/day, target BP is 135/85 mm Hg.
C. Avoid systolic BP less than 100 mm Hgc.
D. For a patient with proteinuria of less than 1 g/day, goal BP is no more than 130/80
mm Hg.
 ANS: D PTS: 1

41. Carol has CKD. Her creatinine levels are now 12 mg/dL. She would like to know what to
expect next. What does the provider tell her?
A. Due to her advanced renal failure, her survival time without intervention is 100 to
150 days.
B. She does not require intervention and she will require dialysis once her creatinine
levels reach 15 mg/dL.
C. She requires dialysis and must have an arteriovenous graft this week to start
dialysis in 1 week.
D. She will be placed on the transplant list once her creatinine levels are greater than
16 mg /dL.
ANS: A PTS: 1