1.The nursing instructor is talking with students about the renal system.

What would the

instructor tell the students about the renal system, especially how it helps maintain
calcium levels in the body by regulating the activation of what?
A)
Vitamin A
B)
Vitamin B
C)
Vitamin C
D)
Vitamin D
Ans:
D
Feedback:
The renal system has four major functions in the body. One is regulating vitamin D
activation, which helps maintain and regulate calcium levels. Vitamins A, B, and C are
not associated with this function.
2.The patient has just been diagnosed with acute renal failure. The patient asks the nurse
what part of his or her kidneys is involved. What would the nurse reply?
A)
Glomerulus
B)
Renal pelves
C)
Nephron
D)
Renal capsule
Ans:
C
Feedback:
The functional unit of the kidney is the nephron. There are about 2.4 million nephrons in
an adult. These structures filter fluid and make urine. The glomerulus is a tuft of blood
vessels with a capillary-like endothelium that allows easy passage of fluid and waste
products. The renal pelves are in a region of the kidney that drains urine into the ureters.
The renal capsule is a protective layer, which is made up of the fiber layer, a perirenal or
brown fat layer, and the renal parietal layer.
3.A patient who has just been told that he or she needs to go on dialysis asks the nurse what
the normal output of urine is per day. What would be the nurse's best response?
A)
2,000 mL
B)
3,000 mL
C)
4,000 mL
D)
5,000 mL
Ans:
A
Feedback:
Approximately 125 mL of fluid is filtered out of the glomerulus each minute. About 99%
is returned to the blood stream as the filtrate progresses through the renal tubule.
Approximately 1% or 2,000 mL of fluid is excreted each day in the form of urine. The
other options are not correct.

A)
B)

4.The anatomy class is learning about the countercurrent mechanism in the medullary
nephrons. What would the students learn about this mechanism and what it acts to do?
Promote sodium excretion
Concentrate or dilute the urine
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C)
D)
Ans:

Block the effects of aldosterone

Stimulate antidiuretic hormone (ADH) release
B
Feedback:
The countercurrent mechanism in the medullary nephrons acts to concentrate or dilute
urine. It does not promote sodium excretion nor does it block the effects of aldosterone.
This mechanism does not stimulate ADH release.

5.The physiology instructor explains that the nephrons are fragile and require a constant
supply of blood and oxygen. What compensatory mechanisms work to maintain this
supply?
A)
The reninangiotensin system, causing vasoconstriction
B)
Baroreceptor monitoring of the renal artery
C)
Increased sweating when total water volume becomes too great
D)
Antidiuretic hormone (ADH) release in response to increased blood volume or
decreased osmolarity
Ans:
A
Feedback:
The reninangiotensin system causes vasoconstriction to improve blood flow to the
fragile nephrons. Baroreceptors are not found in the renal artery. Increased sweating is
not a reflex reaction to increased total body water. ADH is released in response to
decreased blood volume and increased osmolarity.
6.The nursing instructor is discussing anemia. The instructor explains about when a person
has chronic renal failure; how it leads to a decrease in the production of red blood cells
and so the person becomes anemic. This anemia is usually caused by a loss of what?
A)
Erythropoietin
B)
Hydrogen ions
C)
Renin
D)
Urea
Ans:
A
Feedback:
When nephrons are lost, as in renal failure, the juxtaglomerular cells that produce
erythropoietin are also lost leading to a decrease in red blood cell production and anemia.
Urea, renin, and hydrogen do not affect red blood cell production and are not associated
with anemia.

A)
B)
C)

7.As the physiology instructor explains to the students, the kidneys regulate calcium levels
within a very tight range by the activity of the parathyroid hormone (PTH) and calcitonin.
Where does the fine-tuning of the calcium level occur?
Bowman's capsule
The proximal convoluted tubule
The distal convoluted tubule

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D)
Ans:

The loop of Henle

C
Feedback:
PTH acts at the distal convoluted tubule to stimulate the reabsorption of calcium to
increase serum calcium levels; if it is not present, the calcium is lost. Calcium is filtered
at the glomerulus and mostly reabsorbed in the proximal convoluted tubule and the
ascending loop of Henle. Bowman's capsule is part of the renal corpuscle that acts as a
sieve or a strainer to allow fluid to flow through, but also keeps large particles from
entering.

8.A student asks the physiology instructor how the kidneys control body fluid composition.
The instructor explains that the kidneys, by actively removing solutes from the capillary
system for excretion in the urine, perform a process called what?
A)
Glomerular filtration
B)
Tubular reabsorption
C)
Tubular secretion
D)
Tubular metabolism
Ans:
C
Feedback:
Tubular secretion is the movement of solutes from the capillary bed into the renal tubule.
Glomerular filtration is the passing of fluid from the capillary system into the renal tubule
in Bowman's capsule. Tubular reabsorption is the movement of solutes from the tubule
into the capillary system.
9.The students are discussing the electrolytes in the body. What should the students know
has the greatest influence on potassium loss from the body?
A)
Aldosterone
B)
Antidiuretic hormone
C)
Renin
D)
Carbonic anhydrase
Ans:
A
Feedback:
Potassium concentration is regulated throughout the tubules with aldosterone being the
strongest influence for loss. Renin activates angiotensinogen, which becomes angiotensin
I. Antidiuretic hormone is produced by the hypothalamus and stored in the posterior
pituitary gland and is important in maintaining fluid balance. Carbonic anhydrase causes
sodium ions to be reabsorbed and allows carbon dioxide and water to combine to form
carbonic acid. This leads to the formation of sodium bicarbonate, which is stored in the
renal tubules as the body's reserve for use when the body needs a buffer against acid.
10.The students are studying the male reproductive system. The instructor tells the students
that in the male, the urethra leaves the urinary bladder and passes through what?
A)
Vas deferens

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B)
C)
D)
Ans:

Renal calyx
Prostate gland
Renal cortex
C
Feedback:
In the male, the urethra leaves the urinary bladder and passes through the prostate gland.
The renal calyx and cortex are located in the kidney and the urethra does not pass through
the kidney. The vas deferens delivers the sperm from the testicles to the urethra.

11.The nurse admits a patient with a high potassium level. The nurse recognizes this
activates the body's sodiumpotassium exchange leading to which physical symptom?
A)
Dehydration
B)
Water retention
C)
Fatigue
D)
Dizziness
Ans:
B
Feedback:
If potassium levels are very high, the retention of sodium in exchange for potassium also
leads to retention of water and a dilution of blood volume, which decreases potassium
concentration. Dehydration is a lack of volume in the blood vessels, which can lead to
dizziness. Fatigue is a symptom of anemia, which is associated with renal failure.
12.The nurse is caring for a patient suspected of having renal dysfunction. When reviewing
laboratory results for this patient, the nurse recalls that several substances are filtered
from the blood by the glomerulus and these substances are then excreted in the urine. The
nurse identifies the presence of which substances in the urine as abnormal findings?
A)
Potassium and sodium
B)
Bicarbonate and urea
C)
Blood cells and protein
D)
Creatinine and chloride
Ans:
C
Feedback:
The various substances normally filtered by the glomerulus, reabsorbed by the tubules,
and excreted in the urine include sodium, chloride, bicarbonate, potassium, glucose, urea,
creatinine, and uric acid. Within the tubule, some of these substances are selectively
reabsorbed into the blood. Glucose scarring or swelling of or damage to the
semipermeable membrane leads to the escape of larger plasma components such as blood
cells or protein into the filtrate. A clinical sign of renal damage is the presence of blood
cells or protein in the urine.
13.The pathophysiology instructor is talking to the prenursing students about hypovolemia
and the kidneys. The instructor points out that when the blood pressure is low due to
dehydration, the body will compensate by secreting what?

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A)
B)
C)
D)
Ans:

Antidiuretic hormone
Aldosterone
Renin
Angiotensin
C
Feedback:
Regulation of blood pressure is also a function of the kidney. Specialized vessels of the
kidney called the vasa recta constantly monitor blood pressure as blood begins its passage
into the kidney. When the vasa recta detect a decrease in blood pressure, specialized
juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole
secrete the hormone renin. Renin converts angiotensinogen to angiotensin I, which is then
converted to angiotensin II, the most powerful vasoconstrictor known. The
vasoconstriction causes the blood pressure to increase. The cortex of the suprarenal gland
secretes aldosterone in response to stimulation by the pituitary gland, which in turn is in
response to poor perfusion or increasing serum osmolality. The result is an increase in
blood pressure. When the vasa recta recognize the increase in blood pressure, renin
secretion stops. Failure of this feedback mechanism is one of the primary causes of
hypertension. Therefore, options A, B, and D are incorrect.

14.The nurse is aware that which area of the kidney provides quick response to any damage
or injury to the kidney cells?
A)
Juxtaglomerular apparatus
B)
Reninangiotensinaldosterone system
C)
Macula densa
D)
Countercurrent mechanism
Ans:
C
Feedback:
The macula densa consists of immune system cells and chemicals that can respond
quickly to any cellular damage or injury. The juxtaglomerular apparatus produce
erythropoietin and renin. The Reninangiotensinaldosterone system works to maintain
blood flow to the kidneys. The countercurrent mechanism works to concentrate and dilute
the urine.
15.A patient who has signs and symptoms of kidney failure has experienced what percentage
of loss of the nephrons in the kidneys?
A)
10%
B)
25%
C)
50%
D)
75%
Ans:
D
Feedback:
Only 25% of the total number of nephrons is necessary to maintain healthy renal function
so most patients must have experienced nephron loss of at least 75% to have signs and
symptoms of kidney failure. The other options are not correct.

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16.What function does the kidney perform to assist in maintaining acidbase balance within
the necessary normal range?
A)
Excrete acid in the lungs
B)
Return bicarbonate to the body's circulation
C)
Return acid to the body's circulation
D)
Excrete bicarbonate in the urine
Ans:
B
Feedback:
The kidney performs two major functions to assist in this balance. The first is to reabsorb
and return to the body's circulation any bicarbonate from the urinary filtrate; the second is
to excrete acid in the urine. Therefore, options A, C, and D are incorrect.
17.A student asks the physiology instructor how bicarbonate is replaced by the body when a
patient loses it from the body. What should the instructor answer?
A)
The renal tubules secrete new bicarbonate into the urine.
B)
The juxtaglomerular cells secrete new bicarbonate into the blood.
C)
The juxtaglomerular cells generate new bicarbonate.
D)
Renal tubular cells generate new bicarbonate.
Ans:
D
Feedback:
To replace any lost bicarbonate, the renal tubular cells generate new bicarbonate through
a variety of chemical reactions. This newly generated bicarbonate is then reabsorbed by
the tubules and returned to the body. This makes options A, B, and C incorrect.
18.A student asks the pathophysiology instructor what the function of renin is in the body.
What is the instructor's best response to the student's question?
A)
Renin is directly involved in the control of arterial blood pressure and it is
essential for proper functioning of the glomerulus.
B)
Renin is involved in venous blood pressure and controls the flow of blood through
the tubules.
C)
Renin is directly involved in the control of arterial blood pressure and the flow of
blood through the pyramids of the kidney.
D)
Renin is involved in venous blood pressure and it is essential for proper
functioning of the glomerulus.
Ans:
A
Feedback:
Renin is a hormone directly involved in the control of arterial blood pressure. It is
essential for proper functioning of the glomerulus. The other options are not correct.
19.A 78-year-old patient presents at the clinic complaining of urinary problems. The patient
tells the nurse that he experiences frequency, urgency, and has problems initiating and

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A)
B)
C)
D)
Ans:

maintaining a urinary stream. Based on the patient's age, what would the nurse suspect?
Enlarged prostate
Decreased bladder function
Increased kidney function
Partially obstructed ureter
A
Feedback:
The ureters, urinary bladder, and urethra make up the rest of the urinary tract. The longer
male urethra passes through the prostate gland, which may enlarge or become infected, a
problem often associated with advancing age. The patient's advancing age does not
increase the risk of decreased bladder function, increased kidney function, or partially
obstructed ureter.

20.A daughter is talking with the urologist who is caring for the woman's 78-year-old
mother. The mother has multiple sclerosis and has lost control of her bladder. The
daughter asks the urologist what made her mother become incontinent. What would be
the urologist's best answer?
A)
I don't know, but there are lots of medicines we can try to fix it.
B)
After control of the bladder is learned, you must have a functioning nervous
system to maintain it.
C)
Your mother's age has a lot to do with it.
D)
This happens sometimes and no one is quite sure why.
Ans:
B
Feedback:
Control of bladder emptying is learned control over the urethral sphincter. Once it is
established, a functioning nervous system is necessary to maintain control.
21.A young woman presents with signs and symptoms of a urinary tract infection (UTI).
What factor that has the most influence on this situation does the nurse know?
A)
The woman has a short urethra.
B)
The woman has multiple sexual partners.
C)
The woman takes too many bubble baths.
D)
The woman does not clean herself as she should.
Ans:
A
Feedback:
In the female, the urethra is a very short tube that leads from the bladder to an area
populated by normal bacterial flora including Escherichia coli, which can cause frequent
bladder infections or cystitis. Recurrent UTIs do not indicate the woman has multiple
sexual partners, takes too many bubble baths, or does not clean herself adequately.
22.The renal system has several major functions in the body. What are they? (Select all that
apply.)
A)
Acting as a diuretic for the body

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B)
C)
D)
E)
Ans:

Clearing nitrogenous wastes from protein metabolism

Regulating red blood cell production
Regulating blood pressure
Concentrating urine
B, C, D, E
Feedback:
Maintaining the volume and composition of body fluids within normal ranges includes
clearing nitrogenous wastes from protein metabolism; maintaining acidbase balance and
electrolyte levels; excreting various drugs and drug metabolites; regulating vitamin D
activation, which helps to maintain and regulate calcium levels; regulating blood pressure
through the reninangiotensinaldosterone system; and regulating red blood cell
production through the production and secretion of erythropoietin. The renal system does
not act as a diuretic.

23.Where do the collecting ducts meet?

A)
Renal pelves
B)
Loop of Henle
C)
Bowman's capsule
D)
Distal convoluted tubule
Ans:
A
Feedback:
The nephron widens at the distal convoluted tubule, then flows into the collecting ducts,
which meet at the renal pelves. The collecting ducts do not meet in the loop of Henle,
Bowman's capsule, or distal convoluted tubule.
24.A student asks the physiology instructor what regulates the flow of fluid into the
glomerulus by increasing or decreasing pressure on either side of the glomerulus. What
should the instructor respond?
A)
The ascending and descending parts of the loop of Henle
B)
The arterioles
C)
The nephron
D)
The venules
Ans:
B
Feedback:
The two arterioles around the glomerulus work together to closely regulate the flow of
fluid into the glomerulus, increasing or decreasing pressure on either side of the
glomerulus as needed. The loop of Henle is part of the nephron. The nephron does not
regulate blood flow to the glomerulus, and option D is a distracter for this question.
25.Much of the sodium in the filtrate is reabsorbed in the proximal convoluted tubule to the
peritubular capillaries. As the sodium is moved out of the filtrate, what does it take with
it?
A)
Calcium

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B)
C)
D)
Ans:

Magnesium
Chloride ions
Potassium ions
C
Feedback:
As sodium is actively moved out of the filtrate, it takes chloride ions and water with it.
Sodium does not take calcium, magnesium, or potassium ions with it.

26.Sodium ions are reabsorbed into the body by the aid of what catalyst?
A)
Aldosterone
B)
Sodium bicarbonate
C)
Angiotensin
D)
Carbonic anhydrase
Ans:
D
Feedback:
Carbonic anhydrase, an enzyme, speeds the process of carbon dioxide and water
combining to form carbonic acid. The carbonic acid immediately dissociates to form
sodium bicarbonate, using a sodium ion from the renal tubule and a free hydrogen ion (an
acid). The other options are not correct.
27.A student asks the physiology instructor where chloride is primarily reabsorbed. What
would be the instructor's best answer?
A)
The loop of Henle
B)
The nephron
C)
The kidney
D)
The distal convolute tubule
Ans:
A
Feedback:
Chloride is an important negatively charged ion that helps to maintain electrical neutrality
with the movement of cations across the cell membrane. Chloride is primarily reabsorbed
in the loop of Henle, where it promotes the movement of sodium out of the cell. The
other options are not correct.
28.The students are learning about maintaining electrolytes in the body by actions within the
kidney. Where do the students learn the fine-tuning of potassium levels occurs?
A)
Proximal convoluted tubule
B)
Distal convoluted tubule
C)
Loop of Henle
D)
Glomerulus
Ans:
B
Feedback:
The fine-tuning of potassium levels occurs in the distal convoluted tubule, where
aldosterone activates the sodiumpotassium exchange, leading to a loss of potassium.

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Therefore, options A, C, and D are not correct.

29.What releases erythropoietin when blood flow or oxygenation to the nephron is
decreased?
A)
The countercurrent mechanism
B)
The nephron
C)
The juxtaglomerular cells
D)
The glomerulus
Ans:
C
Feedback:
Whenever blood flow or oxygenation to the nephron is decreased (due to hemorrhage,
shock, heart failure, or hypotension), the hormone erythropoietin is also released from the
juxtaglomerular cells. Therefore, options A, B, and D are not correct.
30.The nurse is caring for a patient who is in renal failure. When reviewing the patient's
laboratory values, what would the nurse expect to find?
A)
Increased hematocrit
B)
Increased white blood cell count
C)
Increased platelet count
D)
Decreased hemoglobin
Ans:
D
Feedback:
Erythropoietin is the only known factor that can regulate the rate of red blood cell
production. When a patient develops renal failure and the production of erythropoietin
drops, the production of red blood cells also falls and the patient becomes anemic.
Options A, B, and C are not correct.
31.A nursing instructor is quizzing a group of students about the function of the nephron.
The student must choose which processes that control the function of the nephron to
answer the question correctly? (Select all that apply.)
A)
Filtration
B)
Dilution
C)
Secretion
D)
Reabsorption
E)
Concentration
Ans:
A, C, D
Feedback:
The nephrons function by using three basic processes: filtration, secretion, and
reabsorption. Dilution and concentration are functions of sodium regulation.
32.A student is giving a presentation about the function of antidiuretic hormone and reports
that it is released in response to what stimuli? (Select all that apply.)

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A)
B)
C)
D)
E)
Ans:

Falling blood volume

Parasympathetic stimulation
Rising sodium levels
Rising calcium levels
Rising parathyroid hormone levels
A, C
Feedback:
Antidiuretic hormone (ADH) is released in response to falling blood volume, sympathetic
stimulation, or rising sodium levels. It is not affected by rising calcium or parathyroid
levels. Option B is not correct.

33.A patient is being treated for dehydration and asks the nurse how the body maintains
proper fluid composition and volume. The nurse correctly includes which regulatory
mechanisms? (Select all that apply.)
A)
Concentration of urine
B)
Increased production of erythropoietin
C)
Secretion of electrolytes
D)
Dilution of urine
E)
Increased blood pressure
Ans:
A, C, D
Feedback:
The kidneys regulate the composition of body fluids by balancing the levels of the key
electrolytes, secreting or absorbing these electrolytes to maintain the desired levels. Body
fluid volume is controlled by diluting or concentrating urine. Erythropoietin helps to
increase red blood cell production, which helps increase oxygen to the organs. Increased
blood pressure does not change the volume or composition of body fluids.
34.The nursing instructor is explaining the function of natriuretic hormone in relation to
urine composition. The instructor shares that this hormone is released in response to
which conditions? (Select all that apply.)
A)
Fluid depletion
B)
Fluid overload
C)
Hemodilution
D)
Hemoconcentration
E)
Decreased red blood cell production
Ans:
B, C
Feedback:
Natriuretic hormone is released in response to fluid overload, not fluid depletion and
hemodilution, and not hemoconcentration. Erythropoietin is released in response to
decreased red blood cell production.
35.The nurse, who works in the emergency department, is aware that the reninangiotensin
aldosterone system works to maintain blood flow in the kidneys. What vital sign would

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A)
B)
C)
D)
Ans:

signify the initiation of this system in a trauma patient?

Increased temperature
Decreased pulse
Decreased blood pressure
Pain level of 3 on a scale of 1 to 10
C
Feedback:
The reninangiotensinaldosterone system is initiated in response to changes in blood
volume, so that a decrease in blood pressure would be most likely to initiate this system.
An increase in temperature, a decrease in pulse, and a pain level of 3 would not affect
blood volume.

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