Exam
Name___________________________________
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
1)
The descending limb of the nephron loop ________.
1)
A)
is freely permeable to sodium and urea
B)
contains fluid that becomes more concentrated as it moves down into the medulla
C)
pulls water by osmosis into the lumen of the tubule
D)
is not permeable to water
2)
The ________ artery lies on the boundary between the cortex and medulla of the kidney.
2)
A)
cortical radiate
B)
interlobar
C)
lobar
D)
arcuate
3)
the body.
1. major calyx
2. minor calyx
3. nephron
4. urethra
5. ureter
6. collecting duct
3)
A)
6, 3, 2, 1, 5, 4
B)
3, 6, 2, 1, 5, 4
C)
3, 1, 2, 6, 5, 4
D)
2, 1, 3, 6, 5, 4
4)
Which of the choices below are the most important hormone regulators of electrolyte reabsorption
and secretion?
4)
A)
angiotensin II and ADH
B)
angiotensin I and atrial natriuretic peptide
C)
angiotensin II and aldosterone
D)
angiotensin I and epinephrine
5)
The mechanism of water reabsorption by the renal tubules is ________.
5)
A)
osmosis
B)
active transport
C)
filtration
D)
cotransport with sodium ions
6)
Which cells of the kidney are chemoreceptors that respond to changes in solute content of the
filtrate?
6)
A)
podocytes
B)
juxtaglomerular cells
C)
macula densa cells
D)
mesangial cells
7)
Which of the following is not true regarding tu bular reabso rption?
7)
A)
It occurs via transcellular or paracellular routes.
B)
It is a reclamation process.
C)
It is a purely passive transport process.
D)
It involves hormonal signals in the collecting ducts.
8)
An increase in the permeability of the cells of the collecting tubule to water is due to a(n) ________.
8)
A)
decrease in the production of ADH
B)
decrease in the concentration of the blood plasma
C)
increase in the production of aldosterone
D)
increase in the production of ADH
9)
Reabsorption of high levels of glucose and amino acids in the filtrate is accomplished by ________.
9)
A)
facilitated diffusion
B)
secondary active transport
C)
passive transport
D)
countertransport
10)
Alcohol acts as a diuretic because it ________.
10)
A)
inhibits the release of ADH
B)
increases the rate of glomerular filtration
C)
is not reabsorbed by the tubule cells
D)
increases secretion of ADH
11)
If one says that the clearance value of glucose is zero, what does this mean?
11)
A)
The glucose molecule is too large to be filtered out of the blood.
B)
The clearance value of glucose is relatively high in a healthy adult.
C)
Most of the glucose is filtered out of the blood and is not reabsorbed in the convoluted
tubules.
D)
Normally all the glucose is reabsorbed.
12)
Which of the following is not reabsorbed by the proximal convoluted tubule?
12)
A)
Na+
B)
creatinine
C)
K+
D)
glucose
13)
The glomerulus differs from other capillaries in the body in that it ________.
13)
A)
has a blood pressure much lower than other organ systems
B)
is impermeable to most substances
C)
is drained by an efferent arteriole
D)
has a basement membrane
14)
The fatty tissue surrounding the kidneys is important because it ________.
14)
A)
ensures adequate energy for the adrenal glands to operate efficiently
B)
is necessary as a barrier between the adrenal glands and kidneys
C)
stabilizes the position of the kidneys by holding them in their normal position
D)
produces vitamin D and other chemicals needed by the kidney
15)
Which of the following acts as the trigger for the initiation of micturition (voiding)?
15)
A)
motor neurons
B)
the pressure of the fluid in the bladder
C)
the sympathetic efferents
D)
the stretching of the bladder wall
16)
Which of the following is the least important influence on reabsorption of a substance in the
nephron?
16)
A)
number of carriers.
B)
molecule size relative to fenestrations.
C)
molecular complexity
D)
lipid solubility.
17)
If the Tm for a particular amino acid is 120 mg/100 ml and the concentration of t hat amino acid in
the blood is 230 mg/100 ml, the amino acid will ________.
17)
A)
be completely reabsorbed by secondary active transport
B)
be completely reabsorbed by the tubule cells
C)
be actively secreted into the filtrate
D)
appear in the urine
18)
Which of the hormones below is responsible for facultative water reabsorption?
18)
A)
thyroxine
B)
atrial natriuretic peptide
C)
ADH
D)
aldosterone
19)
The functional and structural unit of the kidneys is the ________.
19)
A)
nephron
B)
capsular space
C)
glomerular capsule
D)
nephron loop
20)
Which of the choices below is not a glomerular filtration rate control method?
20)
A)
neural regulation
B)
renal autoregulation
C)
electrolyte levels
D)
hormonal regulation
21)
Which of the following is not associated with the renal corpuscle?
21)
A)
an efferent arteriole
B)
a vasa recta
C)
a podocyte
D)
a fenestrated capillary
22)
The function of angiotensin II is to ________.
22)
A)
constrict arterioles and increase blood pressure
B)
decrease water absorption
C)
decrease the production of aldosterone
D)
decrease arterial blood pressure
23)
Which of the choices below is a function of the nephron loop?
23)
A)
form a large volume of very dilute urine or a small volume of very concentrated urine
B)
absorb electrolytes actively and water by osmosis in the same segments
C)
absorb water and electrolytes into the tubular network
D)
form a large volume of very concentrated urine or a small volume of very dilute urine
24)
The mechanism that establishes the medullary osmotic gradient depends most on the permeability
properties of the ________.
24)
A)
distal convoluted tubule
B)
nephron loop
C)
collecting duct
D)
glomerular filtration membrane
25)
Which of the following is the correct sequence of kidney development from embryo to fetus?
25)
A)
pronephros, metanephros, mesonephros
B)
mesonephros, metanephros, pronephros
C)
mesonephros, pronephros, metanephros
D)
pronephros, mesonephros, metanephros
26)
The filtration membrane includes all except ________.
26)
A)
podocytes
B)
renal fascia
C)
basement membrane
D)
glomerular endothelium
27)
In the ascending limb of the nephron loop the ________.
27)
A)
thin segment is not permeable to sodium and chloride
B)
thick segment is permeable to water
C)
thick segment moves ions out into interstitial spaces for reabsorption
D)
thin segment is freely permeable to water
28)
The chief force pushing water and solutes out of the blood across the filtration membrane is
________.
28)
A)
protein-regulated diffusion
B)
glomerular hydrostatic pressure (glomerular blood pressure)
C)
the size of the pores in the basement membrane of the capillaries
D)
the ionic electrochemical gradient
29)
The kidneys are stimulated to produce renin ________.
29)
A)
when the pH of the urine decreases
B)
by a decrease in the blood pressure
C)
when the specific gravity of urine rises above 1.10
D)
when the peritubular capillaries are dilated
30)
Select the correct statement about urinary system development.
30)
A)
Kidneys develop from urogenital ridges.
B)
The pronephros (first tubule system) develops during the tenth week of gestation.
C)
The metanephric ducts will become the urethras.
D)
The mesonephros will develop into the kidneys.
31)
Which of the choices below is the salt level-monitoring part of the nephron?
31)
A)
vasa recta
B)
principal cell
C)
macula densa
D)
nephron loop
32)
Which of the choices below is not a method by which the cells of the renal tubules can raise blood
pH?
32)
A)
by reabsorbing filtered bicarbonate ions
B)
by producing new bicarbonate ions
C)
by secreting hydrogen ions into the filtrate
D)
by secreting s odium ions
33)
The macula densa cells respond to ________.
33)
A)
aldosterone
B)
antidiuretic hormone
C)
changes in solute content of the filtrate
D)
changes in pressure in the tubule
34)
Which of the following does not describe the justaglomerular complex?
34)
A)
It regulates the rate of filtrate formation.
B)
Its granular cells produce rennin.
C)
It helps control systemic blood pressure.
D)
Its macula densa cells produce aldosterone.
35)
Select the correct statement about the ureters.
35)
A)
The ureters are capable of peristalsis like that of the gastrointestinal tract.
B)
The epithelium is stratified squamous like the skin, which allows a great deal of stretch.
C)
Ureters contain sphincters at the entrance to the bladder to prevent the backflow of urine.
D)
The ureter is innervated by parasympathetic nerve endings only.
36)
Excretion of dilute urine requires ________.
36)
A)
the presence of ADH
B)
impermeability of the collecting tubule to water
C)
relative permeability of the distal tubule to water
D)
transport of sodium and chloride ions out of the descending nephron loop
37)
Select the correct statement about the nephrons.
37)
A)
The glomerulus is correctly described as the proximal end of the proximal convoluted tubule.
B)
Podocytes are the branching epithelial cells that line the tubules of the nephron.
C)
Filtration slits are the pores that give fenestrated capillaries their name.
D)
The parietal layer of the glomerular capsule is simple squamous epithelium.
38)
The urinary bladder is composed of ________ epithelium.
38)
A)
simple squamous
B)
stratified squamous
C)
transitional
D)
pseudostratified columnar
39)
Which of the following is not a part of the juxtaglomerular complex?
39)
A)
macula densa
B)
podocyte cells
C)
mesangial cells
D)
granular cells
40)
A disease caused by inadequate secretion of antidiuretic hormone (ADH) by the pituitary gland
with symptoms of polyuria is ________.
40)
A)
coma
B)
diabetic acidosis
C)
diabetes mellitus
D)
diabetes insipidus
41)
What would happen if the capsular hydrostatic pressure were increased above normal?
41)
A)
Net filtration would decrease.
B)
Capsular osmotic pressure would compensate so that filtration would not change.
C)
Filtration would increase in proportion to the increase in capsular pressure.
D)
Net filtration would increase above normal.
42)
The renal corpuscle is made up of ________.
42)
A)
the descending nephron loop
B)
the renal papilla
C)
Bowman's capsule and glomerulus
D)
the renal pyramid
43)
Which of the following best describes kidney function in older adults (70 years or older)?
43)
A)
Kidney function decreases due to kidney atrophy.
B)
Only obese and diabetic older adults have any kidney dysfunction.
C)
Kidney function remains the same throughout life, regardless of age.
D)
Only about 3% of older adults have any loss of k idney function.
44)
What is the most direct function of the juxtaglomerular apparatus?
44)
A)
help regulate blood pressure and the rate of excretion by the kidneys
B)
help regulate urea absorption by the kidneys
C)
help regulate blood pressure and the rate of blood filtration by the kidneys
D)
help regulate water and electrolyte excretion by the kidneys
45)
An important characteristic of urine is its specific gravity or density, which is ________.
45)
A)
much higher than water
B)
less than water
C)
slightly higher than water
D)
the same as water
46)
The fluid in the glomerular (Bowman's) capsule is similar to plasma except that it does not contain a
significant amount of ________.
46)
A)
electrolytes
B)
plasma protein
C)
glucose
D)
hormones
47)
The factor favoring filtrate formation at the glomerulus is the ________.
47)
A)
colloid osmotic pressure of the blood
B)
capsular hydrostatic pressure
C)
myogenic mechanism
D)
glomerular hydrostatic pressure
48)
Most electrolyte reabsorption by the renal tubules is ________.
48)
A)
accomplished after the nephron loop is reached
B)
hormonally controlled in distal tubule segments
C)
in the distal convoluted tubule
D)
not limited by a transport maximum
49)
Which of the choices below is not a function of the urinary system?
49)
A)
regulates blood glucose levels and produces hormones
B)
maintains blood osmolarity
C)
eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat
D)
helps maintain homeostasis by controlling the composition, volume, and pressure of blood
50)
Which of the choices below is the least important role of tubular secretion?
50)
A)
disposing of substances not already in the filtrate, such as certain drugs
B)
ridding the body of excessive potassium ions
C)
eliminating undesirable substances such as urea and uric acid that have been reabsorbed by
passive processes
D)
ridding the body of bicarbonate ions
51)
The presence of pus in the urine is a condition called ________.
51)
52)
Glomerulus.
52)
53)
The need to get up in the middle of the night to urinate is called ________.
53)
54)
Afferent arteriole.
54)
Figure 25.2
55)
Cells that reabsorb virtually all the nutrients.
55)
56)
Freshly voided urine has very little smell, but shortly after voiding it can give off a very
strong smell. Why?
56)
57)
What are aquaporins?
57)
58)
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.
58)
59)
Collecting duct cells.
59)
Figure 25.1
60)
Collecting duct.
60)
Figure 25.2
61)
Almost no water is absorbed in these cells.
61)
62)
Explain how filtration works in the glomerular capillaries.
62)
Figure 25.2
63)
Podocyte.
63)
64)
List and describe three pressures operating at the filtration membrane, and explain how
each influences net filtration pressure.
64)
Figure 25.1
65)
Structure most closely associated with granular cells.
65)
Figure 25.2
66)
Proximal convoluted tubule cells.
66)
67)
The ________ mechanism is the general tendency of vascular smooth muscle to contract
when stretched.
67)
Figure 25.2
68)
Filtrate at the site of these cells is about the same osmolarity as blood plasma.
68)
Figure 25.1
69)
Medulla of the kidney.
69)
70)
Nephron loop.
70)
71)
Explain what is meant by the terms cotransport process and transport maximum.
71)
72)
Explain the role of aldosterone in sodium and water balance.
72)
Figure 25.1
73)
Peritubular capillaries.
73)
74)
The area between the ureters and urethra is called the ________ in a bladder.
74)
Figure 25.2
75)
Is composed of simple squamous epithelium.
75)
76)
Cells that are the most active in reabsorb ing the filtrate.
76)
77)
Sodium-linked water flow across a membrane not under hormonal control is called
________ water reabsorption.
77)
78)
ADH activated water channels called ________ are essential for water reabsorption in the
collecting duct.
78)
79)
List three substances that are abnormal urinary constituents and provide the proper
clinical term for such abnormalities.
79)
80)
Cells that are most affected by ADH.
80)
81)
Glomerular filtration is an ATP-driven process.
81)
82)
The collecting duct is impermeable to water in the presence of ADH.
82)
83)
The entire responsibility for urine formation lies with the nephron.
83)
84)
If the GFR is too low, needed substances may pass so quickly through the renal tubules that they
are not absorbed and instead are lost in the urine.
84)
85)
through the nephron loop of the juxtamedullary nephrons (the countercurrent multiplier) and the
flow of blood through the limbs of adjacent blood vessels (the countercurrent exchanger). This
relationship establishes and maintains an osmotic gradient extending from the cortex through the
depths of the medulla that allows the kidneys to vary urine concentration dramatically.
85)
86)
Blood in the urine may be a symptom of bladder cancer.
86)
87)
An excessive urine output is called anuria.
87)
88)
Water reabsorption through the proximal convoluted tubule is termed obligatory water
reabsorption, whereas water reabsorption through the distal convoluted tubule is termed
facultative water reabsorption.
88)
89)
The path urine takes after it is formed until it leaves the body is the urethra, urinary bladder, and
finally the ureter.
89)
90)
The trigone is so named because of the shape of the urinary bladder.
90)
91)
Urea is reabsorbed in the nephron loop.
91)
92)
Tubular secretion is effective in controlling blood pH.
92)
93)
The urethra contains an internal sphincter of smooth muscle.
93)
94)
In the absence of hormones, the distal tubule and collecting ducts are relatively impermeable to
water.
94)
95)
Blood pressure in the renal glomerulus is lower than in most parts of the body in order to conserve
body water.
95)
96)
The myogenic mechanism reflects the tendency of vascular smooth muscle to stretch.
96)
97)
Having a kinked ureter is called renal ptosis.
97)
98)
Incontinence is the inability to control voluntary micturition.
98)
99)
The position of the kidneys behi nd the peritoneal lining of the abdominal cavity is described by the
term retroperitoneal.
99)
100)
The proximal convoluted tubule is the portion of the nephron that attaches to the collecting duct.
100)
101)
Atrial natriuretic peptide inhibits sodium reabsorption.
101)
102)
Fetal kidneys have the primary responsibility of clearing wastes from the fetal blood.
102)
103)
Obligatory water reabsorption involves the movement of water along an osmotic gradient.
103)
104)
The act of emptying the bladder is called voiding.
104)
105)
The macula densa cells are chemoreceptors that respond to changes in the urea content of the
filtrate.
105)
106)
Angiotensin II is a substance made by the body to lower blood pressure during stress.
106)
107)
Aldosterone is a hormone that causes the renal tubules to reclaim sodium ions from the filtrate.
107)
108)
Both the male and female urethras serve the urinary and the reproductive systems.
108)
bundles of long straight vessels.
109)
reabsorb solutes and water from the
tubule cells.
111)
Match the following:
of all plasma elements but not blood
cells.
and solutes into the glomerular
capsule.
116)
Play a role in urine concentration.
B)
Vasa recta
114)
115)
117)
Glomerulus.
A)
Site of filtrate formation.
118)
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.
119)
What clinical effects would low blood pressure have on the kidneys of a burn patient?
120)
An 18 year old patient 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?
121)
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. Plain X-rays indicate a radiopaque
(whitish) spot in the area of his right ureter. Diagnose his problem. Give suggested treatment and prognosis.
122)
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?
123)
Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective as
an antihypertensive.
124)
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.
125)
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 Key
1)
B
2)
D
3)
B
4)
C
5)
A
6)
C
7)
C
8)
D
9)
B
10)
A
11)
D
12)
B
13)
C
14)
C
15)
D
16)
C
17)
D
18)
C
19)
A
20)
C
21)
B
22)
A
23)
A
24)
B
25)
D
26)
B
27)
C
28)
B
29)
B
30)
A
31)
C
32)
D
33)
C
34)
D
35)
A
36)
B
37)
D
38)
C
39)
B
40)
D
41)
A
42)
C
43)
A
44)
C
45)
C
46)
B
47)
D
48)
B
49)
C
50)
D
30
51)
pyuria
52)
C
53)
nocturia
54)
A
55)
E
56)
Freshly voided urine is relatively sterile but if it is allowed to stand, bacteria begin to metabolize the urea solutes to
57)
Aquaporins are transmembrane proteins that form water-filled pores in water-permeable portions of the convoluted
58)
Facultative water reabsorption depends on the presence of antidiuretic hormone. In the presence of ADH, the pores of
59)
C
60)
B
61)
D
62)
The glomerular capillaries are fenestrated, allowing fairly large molecules to pass through. The substances must pass
63)
B
64)
higher the glomerular hydrostatic pressure, the more filtrate is pushed across the membrane. Colloid osmotic pressure
65)
A
66)
E
67)
myogenic
68)
E
69)
E
70)
E
71)
Cotransport process refers to the active transport of one solute "uphill" (against a concentration gradient) coupled to
72)
Aldosterone targets the distal tubule and collecting duct and enhances sodium ion reabsorption so that very little
73)
D
74)
trigone
75)
A
76)
E
77)
obligatory
78)
aquaporins
79)
Abnormal urinary constituents include the following (the clinical term for each is listed in parentheses): glucose
80)
C
Answer Key
109)
A
110)
A
111)
A
112)
A
113)
B
114)
C
115)
A
116)
B
117)
A
118)
Harry is showing the symptoms of kidney inflammation. Kidney inflammations usually result from infections either of
119)
would have a low GFR. This is highly dangerous, leading to failure of the nephron loop to maintain countercurrent
120)
account for 80% of all urinary tract infections. The nurse can instruct the patient on proper hygiene measures,
Answer Key
121)
The symptoms indicate a kidney stone that has been passed into the ureter. Recommended treatments include be IV
122)
large amounts of plasma proteins (mostly albumin) pass into the glomerular filtrate and are excreted in the urine. If the
123)
Angiotensin II is a potent vasoconstrictor activating smooth muscle of arterioles throughout the body, causing mean
124)
Stress incontinence is found most commonly in women with relaxed pelvic musculature deprived of estrogen. Stress
125)
and bleeding occurs. This condition is caused by bacterial invasion of the bladder or by chemical or mechanical