NSG 530 Ch.7 Questions and Verified Detailed Answers; for Guaranteed Success -Wilkes University

Kidneys

Filter blood, regulate fluid/electrolytes, acid-base balance, blood pressure, vitamin D activation, and erythropoietin production.

Ureters

Transport urine from kidneys to bladder via peristalsis.

Bladder

Stores urine; stretch receptors trigger urge to void.

Urethra

Conducts urine out of the body.

Key Regulatory Functions

Fluid volume, blood pressure (RAAS, ADH, natriuretic peptides), waste excretion, acid-base balance, and hormone synthesis (renin, EPO).

Glomerulus

The site of filtration in the nephron.

Tubules

The site of reabsorption and secretion in the nephron.

Collecting Ducts

Responsible for final urine concentration.

Glomerular Filtration

Movement of plasma into Bowman's capsule.

Tubular Reabsorption

Return of needed solutes and water to the blood.

Tubular Secretion

Transfer of wastes and excess ions into the filtrate.

Requirements for normal urine production

Normal renal perfusion, functional glomeruli, and intact tubules for reabsorption/secretion.

Typical urine composition

Water, electrolytes, urea, creatinine, uric acid, metabolic by-products, and medications.

Urine elimination pathway

Kidneys → ureters → bladder → urethra.

Bladder fills; stretch receptors activated around 200-300 mL

Signal to brain initiates voiding reflex

Relaxation of internal & external sphincters allows urination

Volume that triggers the voiding reflex

200-300 mL (activates bladder stretch receptors).

Normal bladder capacity

Approximately 300-500 mL.

Age-related renal changes

Reduced renal blood flow, reduced GFR, decreased concentration ability, and increased nocturia.

Stress incontinence

Loss of urine with increased abdominal pressure.

Urge incontinence

Sudden urge leading to involuntary loss of urine.

Overflow incontinence

Bladder unable to empty, leading to dribbling.

Mixed incontinence

Combination of multiple types of urinary incontinence.

Functional incontinence

Incontinence due to physical or cognitive barriers to toileting.

Gross total incontinence

Continuous urinary leakage.

Transient incontinence

Incontinence caused by a reversible condition like UTI or medications.

Risk factors for urinary incontinence

Female sex, age, obesity, smoking, and chronic diseases.

Complications of urinary incontinence

Skin breakdown, infections, and psychosocial impacts.

Diagnostic tools for urinary incontinence

History & physical, urinalysis, bladder diaries, post-void residual, and urodynamic tests.

Management of urinary incontinence

Behavioral strategies, pelvic floor strengthening, medications, and devices or surgical interventions.

Neurogenic bladder

Bladder dysfunction caused by an interruption of the nerve supply.

Causes of neurogenic bladder

Spinal cord injury, multiple sclerosis (MS), diabetes, or stroke.

Spastic (overactive) neurogenic bladder symptoms

Urgency, frequency, and urge incontinence.

Flaccid (underactive) neurogenic bladder symptoms

Urinary retention and overflow incontinence.

Diagnostic methods for neurogenic bladder

History, bladder diary, urinalysis, and imaging.

Treatment for neurogenic bladder

Incontinence management strategies and catheterization for retention.

Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) characteristics

Chronic bladder pain without infection, often associated with other chronic pain conditions.

Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) symptoms

Suprapubic pain with bladder filling, urinary frequency, and urgency.

Bladder Pain Syndrome / Interstitial Cystitis (BPS/IC) management

Symptom control, dietary modification, medications, and bladder training.

Congenital Urinary Disorders general features

Structural abnormalities of urinary or reproductive system, varying from asymptomatic to life-threatening.

Most severe congenital urinary disorder feature

Abnormal kidney development.

Upper tract UTI type

Pyelonephritis.

Lower tract UTI types

Cystitis and urethritis.

Most common cause of UTIs

Bacterial invasion, most often E. coli.

Population with higher frequency of UTIs

Women.

Symptoms of cystitis

Dysuria, urgency, frequency, suprapubic pain, and cloudy foul urine.

Symptoms of pyelonephritis

Fever, flank pain, and costovertebral angle (CVA) tenderness.

Diagnosis of UTIs

Urinalysis, culture, and assessment of recurrent or complicated UTIs.

Treatment and prevention of UTIs

Antibiotics based on organism; hydration, hygiene, and voiding habits.

Most common type of kidney stone (nephrolithiasis)

Calcium oxalate or calcium phosphate stones.

Risk factors for nephrolithiasis

Dehydration, dietary factors, and metabolic abnormalities.

Symptoms of nephrolithiasis

Colicky flank pain, hematuria, dysuria, nausea/vomiting, and fever/chills.

Diagnosis of nephrolithiasis

Urinalysis, CT scan, and parathyroid testing if calcium stones.

Treatment of nephrolithiasis

Pain management, hydration, medications to aid passage, surgery, and recurrence prevention.

Wilms Tumor (Nephroblastoma)

Rare childhood kidney cancer usually due to abnormal embryonic kidney development.

Wilms Tumor prognosis

Good prognosis with early detection.

Wilms Tumor symptoms

Abdominal mass or swelling, hematuria, and hypertension.

Wilms Tumor treatment

Surgical excision; staging guides management.

Simple Renal Cysts

Usually benign fluid-filled sacs in the kidney.

Complex Renal Cysts

Renal cysts with a higher risk of malignancy, classified via the Bosniak system.

Renal cyst evaluation

CT scan is used for evaluation.

Most common adult kidney cancer

Renal Cell Carcinoma

Renal Cell Carcinoma clinical presentation features

Often metastatic at diagnosis; early disease is often silent.

Renal Cell Carcinoma symptoms

Hematuria, flank pain, abdominal mass, and unexplained weight loss.

Renal Cell Carcinoma diagnosis methods

CT imaging and biopsy.

Renal Cell Carcinoma primary treatment

Nephrectomy

Most common type of bladder cancer

Urothelial (transitional) cell carcinoma

Strongest risk factor for bladder cancer

Smoking

Primary symptom of bladder cancer

Painless hematuria (gross or microscopic)

Bladder cancer management options

Depends on staging (TURBT, intravesical therapy, surgery).

Benign Prostatic Hyperplasia (BPH) definition

Nonmalignant enlargement of the prostate driven by stromal cell proliferation.

Benign Prostatic Hyperplasia (BPH) symptoms

Lower urinary tract symptoms (LUTS) including hesitancy, weak stream, nocturia, and incomplete emptying.

Benign Prostatic Hyperplasia (BPH) diagnosis

History & physical and PSA measurement.

Benign Prostatic Hyperplasia (BPH) treatment

Medications or procedures to reduce obstruction.

Prostate Cancer key features

Most common cancer in men, higher incidence in Black men, typically adenocarcinoma.

Prostate Cancer symptoms

Often asymptomatic, but can present with LUTS similar to BPH.

Prostate Cancer diagnosis

Biopsy.

Prostate Cancer management

Stage-based (active surveillance → surgery/radiation → systemic therapy).

Polycystic Kidney Disease (PKD)

Inherited disorder characterized by clusters of renal cysts leading to renal impairment.

PKD neonatal manifestations

Enlarged kidneys, respiratory issues, and hypertension.

PKD adult manifestations

Back/flank pain, hematuria, hypertension, and progressive renal dysfunction.

PKD diagnosis

Imaging (ultrasound/CT) and genetic testing.

PKD management

Supportive care, blood pressure control, and prevention of complications.

Diffuse vs. focal glomerular disorders

Diffuse affects most glomeruli; focal affects only some glomeruli.

Global vs. segmental glomerular disorders

Global affects the entire glomerulus; segmental affects only a portion.

Glomerular injury patterns

Proliferative, sclerosing, and necrotizing.

Glomerular disorder mechanisms

Immunologic/non-immunologic injury and complement activation leading to proteinuria.

Nephritic Syndrome characteristics

Inflammatory glomerular injury, hematuria, variable proteinuria, hypertension, and reduced GFR.

Types of Nephritic Syndrome

RPGN (cresent formation)

acute postinfectious GN (post-strep)

anti-GBM disease

IgA nephropathy (Berger's disease)

IgA vasculitis

Rapidly progressive glomerulonephritis (RPGN) hallmark

Crescent formation in the glomeruli.

Nephrotic Syndrome characteristics

Podocyte injury, massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia.

Causes of Nephrotic Syndrome

Primary kidney diseases or secondary diseases (e.g., diabetes, lupus).

Primary glomerular diseases causing Nephrotic Syndrome

Minimal change disease, membranous nephropathy, and focal segmental glomerulosclerosis.

Prerenal Acute Kidney Injury (AKI)

AKI caused by poor renal perfusion.

Intrarenal Acute Kidney Injury (AKI)

AKI caused by structural kidney damage.

Postrenal Acute Kidney Injury (AKI)

AKI caused by urinary tract obstruction.

Phases of Acute Kidney Injury (AKI)

Initial (symptomless), Oliguric (↓ GFR/retention), Diuretic (high output/dehydration risk), and Recovery (gradual return).

Oliguric phase of AKI characteristics

Decreased GFR, fluid retention, and electrolyte imbalances.

Diuretic phase of AKI characteristics

High urine output and risk of dehydration.

Recovery phase of AKI

gradual return of function

Management of Acute Kidney Injury (AKI)

Address the underlying cause and manage fluids and electrolytes.

Chronic Kidney Disease (CKD) features

Irreversible, progressive nephron loss.