---> Genitourinary Nursing (Questions 11-15)

11. A 56-year-old man with a 60 pack-year smoking history and normal fluid intake presents to his physician with 2 months of fatigue and weakness accompanied by cough and mild dyspnea. The patient’s vital signs are normal, but a lower left lobe mass is noted on x-ray of the chest. Biopsy leads to the diagnosis of small cell carcinoma. Laboratory tests show:

Plasma Na+: 125 mEq/L
Plasma K+: 3.9 mEq/L
Plasma CO2: 24 mEq/L
Plasma osmolality: 253 mOsm/L
Urine Na+: 48 mEq/L
Urine osmolality: 280 mOsm/L

The hormone most likely responsible for this patient’s abnormal laboratory values has which of the following direct effects?

(A) Activation of G-protein coupled receptors in the adrenal cortex elevates cAMP levels and leads to increased production and secretion of corticosteroids
(B) Activation of G-protein coupled receptors in the hypothalamus results in elevated cAMP levels and inhibition of hypothalamic- induced thirst mechanism
(C) Cleavage of angiotensinogen to angiotensin I leads to an increase in both aldosterone levels and total peripheral resistance
(D) Activation of V2 receptors results in the insertion of aquaporins into the renal collecting duct; activation of V1 receptors leads to an increase in total peripheral resistance


12. A 24-year-old man who is in the hospital for treatment of a severe gram-negative infection subsequently becomes oliguric. He is also having difficulty hearing the hospital staff. Laboratory studies show elevated BUN and creatinine levels. Which of the following is the most likely cause of this patient’s symptoms?

(A) Chloramphenicol
(B) Doxycycline
(C) Erythromycin
(D) Gentamicin

13. A 50-year-old man with a history of large bowel obstruction is diagnosed with colon cancer and undergoes resection of his colon. He returns to his physician for his regular checkup and complains that in the past 3 weeks he has not been feeling well and has noticed significant swelling of his legs. On physical examination, the physician notes 2+ pitting edema and a blood pressure of 155/94 mm Hg. Urinalysis shows 4+ protein with no RBCs or casts. The patient has otherwise been healthy. Which of the following would most likely be present on a kidney biopsy from this patient?

(A) A spike-and-dome pattern of deposition on electron microscopy
(B) A tram-track pattern on light microscopy
(C) Lumpy subepithelial deposits on light microscopy
(D) Nonlinear mesangial staining with IgA immunofluorescence

14. A 35-year-old woman presents to the emergency department after experiencing the acute onset of right flank pain and fever. Laboratory results show white cell casts in the urine. Which of the following is the most prominent cell type found in the infiltrate of the involved organ?

(A) Macrophage
(B) Monocyte
(C) Plasma cell
(D) Polymorphonuclear leukocytes

15. A 22-year-old college student is brought to the emergency department after he began complaining of ants crawling over his body and his friends noted increasing agitation and threatening gestures. On physical examination he is febrile, restless, and tachycardic, and his pupils are markedly dilated. Appropriate treatment would most likely include which of the following?

(A) Acidifying urine to increase renal clearance
(B) Alkalinizing urine to increase renal clearance
(C) Treating with flumazenil
(D) Treating with naloxone


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---> Disorders of the Kidneys (Questions 6-10)