Chapter 25 The Urinary System Exam

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Chapter 25 The Urinary System Short answer Exam Fill-in-the-blank Exam Clinical / essay Exam
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Fill-in-the-Blank/Short Answer Questions

1) The capillary bed that surrounds the descending and ascending loop of Henle of
juxtamedullary nephrons is called the ________.

Answer: vasa recta
Page Ref: 968


2) Urine crystals in the renal pelvis are called ________.

Answer: renal calculi
Page Ref: 986


3) The need to get up in the middle of the night to urinate is called ________.

Answer: nocturia
Page Ref: 991


4) The area between the ureters and urethra is called the ________ in a bladder.

Answer: trigone
Page Ref: 986


5) The ________ mechanism is the general tendency of vascular smooth muscle to contract when

Answer: myogenic
Page Ref: 972


6) The presence of pus in the urine is a condition called ________.

Answer: pyuria
Page Ref: 985; Tbl. 25.2


7) Sodium-linked water flow across a membrane is called ________ water reabsorption.

Answer: obligatory
Page Ref: 975


8) Explain how filtration works in the glomerular capillaries.

Answer: The glomerular capillaries are fenestrated, allowing fairly large molecules to pass through. The substances must pass through the basement membrane, where they are further selected for size by the filtration slits of the podocytes.
Page Ref: 969, 971


9) List three substances that are abnormal urinary constituents and provide the proper clinical
term for such abnormalities.

Answer: Abnormal urinary constituents include the following (the clinical term for each is listed in parentheses): glucose (glycosuria), proteins (proteinuria or albuminuria), ketone bodies (ketonuria), hemoglobin (hemoglobinuria), bile pigments (bilirubinuria), erythrocytes (hematuria), and leukocytes (pyuria).
Page Ref: 985; Tbl. 25.2


10) Explain the role of aldosterone in sodium and water balance.

Answer: Aldosterone targets the distal tubule and collecting duct and enhances sodium ion reabsorption so that very little leaves the body in urine. Aldosterone also causes increased water reabsorption because, as sodium is reabsorbed, water follows it back into the blood.
Page Ref: 978


11) Explain what is meant by the terms cotransport process and transport maximum.

Answer: Cotransport process refers to the active transport of one solute "uphill" (against a concentration gradient) coupled to the "downhill" (with a concentration gradient) movement of another during tubular reabsorption. Transport maximum reflects the number of carriers in the renal tubules available to "ferry" a particular substance.
Page Ref: 975-976


12) Humans can survive for a period of time without water thanks to the ability of the kidneys to produce concentrated urine. Briefly explain the factors that allow this to happen.

Answer: Facultative water reabsorption depends on the presence of antidiuretic hormone. In the presence of ADH, the pores of the collecting tubule enlarge and the filtrate loses water by osmosis as it passes through the medullary regions of increasing osmolarity. Consequently, water is conserved and urine becomes concentrated. The water that passes through these regions is reabsorbed by the body in order to prevent dehydration.
Page Ref: 981


13) List and describe three pressures operating at the filtration membrane, and explain how each
influences net filtration pressure.

Answer: Glomerular hydrostatic pressure is the chief force pushing water and solutes across the filtration membrane. The higher the glomerular hydrostatic pressure, the more filtrate is pushed across the membrane. Colloid osmotic pressure of plasma proteins in the glomerular blood, and capsular hydrostatic pressure exerted by fluids in the glomerular capsule, drive fluids back into the glomerular capillaries. The net filtration pressure equals glomerular hydrostatic pressure minus the sum of colloid osmotic pressure of glomerular blood and capsular hydrostatic pressure.
Page Ref: 969, 971


14) In addition to the renin-angiotensin mechanism, the renal cells produce other chemicals.
Name four, and briefly give the main function of each.

Answer: Renal cells also produce chemicals, some of which act locally as signaling molecules. These chemicals include prostaglandins (vasodilators and
vasoconstrictors), which probably regulate GFR; nitric oxide, a potent vasodilator produced by the
vascular endothelium; adenosine, which constricts renal vasculature; and endothelin, a vasoconstrictor that inhibits renin release.
Page Ref: 972-974


15) What are aquaporins?

Answer: Aquaporins are water-filled pores in water permeable portions of the convoluted tubules such as the PCT.
Page Ref: 975


16) Freshly voided urine has very little smell, but shortly after voiding it can give off a very
strong smell. Why?

Answer: Freshly voided urine is relatively sterile but if it is allowed to stand, bacteria begin to metabolize the urea solutes to release ammonia and other smells depending on the person's diet. A fruity smell generally means there is a diabetes problem.
Page Ref: 985


Clinical Questions

1) An older man sees his doctor for severe pain in his lower abdominal or flank area, elevated temperature, and nausea. Exhaustive tests rule out abdominal obstructions and infections. X rays indicate a shadow on his right ureter. Diagnose his problem. Give suggested treatment and prognosis.

Answer: The symptoms indicate a kidney stone that has been passed into the ureter. Treatment would be IV therapy to flush the stone out, surgery, or ultrasound waves to shatter the calculi. The prognosis is for complete recovery. There is a possibility of kidney stones forming again.
Page Ref: 986


2) What clinical effects would high blood pressure have on the kidneys of a bedridden patient?

Answer: This patient would have a much higher glomerular hydrostatic pressure and would
therefore lose more fluids than normal. Because of the threat of dehydration, the staff should
make sure the patient drinks plenty of water.
Page Ref: 969, 971


3) Eleven-year-old Harry is complaining of a severe sore throat and gets to stay home from
school. His pediatrician prescribes a course of broad-spectrum antibiotics, and Harry feels much
better within a few days. However, some two weeks later, Harry has a dull, bilateral pain in his
lower back and his urine is a smoky brown color. On the basis of Harry's signs and symptoms,
diagnose his condition and indicate the relationship (if any) between his present condition and
his earlier sore throat.

Answer: Harry is showing the symptoms of kidney inflammation. The smoky brown color of the
urine indicates the presence of blood or bile. Kidney inflammations usually result from infections
either of the lower urinary tract or, in Harry's case, from his earlier infection of a sore throat. The
kidney inflammation is called either pyelitis (involves only the renal pelvis and calyces) or
pyelonephritis (affects the whole kidney).
Page Ref: 988


4) Ellen, a 47-year-old woman who has suffered kidney disease for several years, has been
diagnosed with proteinuria. Her legs and feet are so swollen that she has difficulty walking. Her
hands and her left arm are also swollen. What is proteinuria, and could this condition be playing
a role in her swollen limbs?

Answer: Proteinuria is a condition in which the permeability of the glomerular capillaries is
increased to such an extent that large amounts of plasma proteins (mostly albumin) pass into the
glomerular filtrate and are excreted in the urine. If the condition is severe, the loss of plasma
proteins may decrease osmotic pressure substantially. When this happens there is a tendency for
fluid to leave the systemic blood vessels and enter the tissue space. This is the reason for Ellen's
swollen limbs.
Diff: 3 Page Ref: 985


5) Rachael has been complaining of frequent and burning urination. She also reported seeing
some blood in her urine. Her physician suspects cystitis. What is cystitis, and how can it cause
these symptoms?

Answer: It is possible that Rachael has cystitis, a condition in which the mucous membrane
lining the bladder becomes swollen and bleeding occurs. This condition is caused by bacterial
invasion of the bladder or by chemical or mechanical irritation.
Page Ref: 988


6) A patient is 18 years old and has a complaint of painful urination, fever, chills, and back pain.
This is her second urinary tract infection (UTI) within 5 months. How can the RN instruct the
patient on prevention of another UTI?

Answer: Escherichia coli are normal residents of the digestive tract and generally cause no
problems there, but these bacteria account for 80% of all urinary tract infections. The nurse can
instruct the patient on proper hygiene measures. The nurse should also explain that sexually
transmitted infections can also inflame the urinary tract, clogging some of its ducts.
Page Ref: 988


7) A 58-year-old woman complains of loss of urine when coughing and sneezing, and during
exercise. She has had three children. Describe the possible causes of urinary incontinence in
this patient.

Answer: Stress incontinence is found most commonly in women with relaxed pelvic
musculature deprived of estrogen. Stress incontinence may occur with a sudden increase in
intra-abdominal pressure such as coughing or sneezing, which forces urine through the external
Page Ref: 988


8) Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril
would be effective as an antihypertensive.

Answer: Angiotensin II is a potent vasoconstrictor activating smooth muscle of arterioles
throughout the body, causing mean arterial blood pressure to rise. ACE inhibitors reduce blood
pressure by interrupting the renin-angiotensin-aldosterone system.
Page Ref: 972-974


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