Chapter 32 Review

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Chapter 32 Review : 

Chapter 32 Review Renal & Urologic Emergencies

Slide 2: 

1. Which of the following statements regarding the renal system is MOST correct?  A) Urinary tract infections are more prevalent in men.  B) The kidneys are located in the retroperitoneal space.  C) Urinary tract infections are the most common renal disease.  D) The urethra transports urine from the kidneys to the bladder.

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2. Disequilibrium syndrome is a condition in which:  A) large amounts of water move by osmosis into the brain, resulting in an acute subdural hematoma.  B) dialysis patients miss one or two of their treatments, resulting in hyperkalemia, azotemia, and hypotension.  C) water initially shifts from the bloodstream into the cerebrospinal fluid, causing an increase in intracranial pressure.  D) the concentration of urea in the bloodstream is lowered slowly, while the solute concentration of the cerebrospinal fluid remains high.

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3. As the filtrate passes through the rest of the nephron, tubular resorption and tubular secretion convert it to:  A) salt.  B) water.  C) urine.  D) glucose.

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4. A 20-year-old man was kicked in the groin during an assault. He is conscious and alert but is in excruciating pain. Your assessment reveals marked swelling and ecchymosis to his testicular area but no bleeding. The remainder of your exam is remarkable only for abrasions and minor bleeding. The patient's blood pressure is 150/90 mm Hg, pulse rate is 120 beats/min and strong, and respirations are 24 breaths/min with adequate depth. In addition to supplemental oxygen as needed, the MOST appropriate prehospital treatment for this patient involves:  A) applying ice packs to his groin, transporting to the hospital, and considering narcotic analgesia en route.  B) ensuring that he is in a comfortable position and starting two large-bore IV lines en route to a trauma center.  C) reducing his testicular swelling with chemical heat packs, transporting, and providing emotional support en route.  D) starting at least one large-bore IV line and administering a 20 mL/kg normal saline bolus to ensure adequate renal output.

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5. Common signs and symptoms of a lower urinary tract infection include all of the following, EXCEPT:  A) gross hematuria.  B) painful urination.  C) increased urinary frequency.  D) localized pain in the pelvis.

Slide 7: 

6. Most urinary tract infections:  A) are asymptomatic and are diagnosed when a urinalysis is performed during a routine physical exam.  B) occur in women due to the relatively short urethra and its close proximity to the vagina and rectum.  C) involve the lower urinary tract in males because the urethra's large surface area can house more bacteria.  D) are the result of viruses or fungi entering the external urethral opening secondary to poor personal hygiene.

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7. The MOST important therapy the paramedic can administer to a patient with an isolated renal calculus is:  A) oxygen.  B) rehydration.  C) analgesia.  D) an antiemetic.

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8. The MOST common clinical presentation of a patient with blunt renal trauma is:  A) flank pain and hematuria.  B) severe, unexplained shock.  C) groin pain and hypotension.  D) lower back pain and oliguria.

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9. The glomerular filtration rate is MOST accurately defined as the:  A) percentage of filtrate that remains in the kidneys.  B) amount of filtrate produced by the kidneys per minute.  C) volume of blood that flows through the kidneys per minute.  D) pressure in the glomerulus that forces filtrate from the blood.

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10. A 70-year-old female dialysis patient presents with a headache. She is conscious and alert, has a blood pressure of 190/100 mm Hg, a pulse rate of 90 beats/min and regular, and respirations of 14 breaths/min and regular. In addition to administering supplemental oxygen, you should:  A) recognize that she probably received an overaggressive dialysis treatment.  B) start an IV line with normal saline and infuse 200 mL of normal saline per hour.  C) transport at once, start an IV line en route, and give nitroglycerin to lower her blood pressure.  D) monitor her cardiac rhythm, transport, and start an IV line en route to the hospital.

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11. You are dispatched to a residence for an elderly man with an altered mental status. As you are assessing the patient, his wife tells you that he goes to dialysis several time a week, but has missed his last 3 treatments because their car broke down. The patient's skin is yellow, his blood pressure is 98/60 mm Hg, and his pulse rate is 118 beats/min. The ECG reveals sinus tachycardia with peaked T waves. Your MOST immediate concern should be the potential for:  A) severe hypovolemia.  B) acute bradycardia or heart block.  C) lethal ventricular dysrhythmias.  D) hypokalemia-induced cardiac arrest.

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12. Azotemia is defined as:  A) electrolyte disturbances in the blood.  B) an accumulation of uric acid in the blood.  C) increased nitrogenous wastes in the blood.  D) excess potassium excretion by the kidneys.

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13. Unlike peritoneal dialysis, hemodialysis:  A) is associated with a higher risk of peritonitis.  B) filters nitrogenous wastes products from the blood.  C) involves the circulation of blood through a machine.  D) is only used for patients experiencing acute renal failure.

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14. The structural and functional unit of the kidney is the:  A) nephron.  B) medulla.  C) renal cortex.  D) podocyte.

Slide 16: 

15. Which of the following patients is at HIGHEST risk for a bladder injury?  A) Football player who gets speared in the flank  B) Elderly woman who falls and fractures her hip  C) Young male patient who is kicked in the groin  D) Intoxicated driver with obvious pelvic trauma

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16. In addition to supporting airway, breathing, and circulation, the MOST important prehospital intervention for the patient with acute or chronic renal failure is:  A) IV fluid boluses.  B) prompt transport.  C) pain management.  D) electrolyte management.

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17. ECG monitoring of a patient with a suspected urologic emergency is especially important because of:  A) myocardial ischemia that is often caused by urologic dysfunction.  B) the medications that many patients with urologic problems are taking.  C) the potential for electrolyte imbalances and their effect on the heart.  D) frequent fluctuations in the patient's heart rate caused by severe pain.

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18. A 17-year-old man was speared in the flank area during a high school football game. He complains of severe pain to his left flank and is very restless. His blood pressure is 86/56 mm Hg, pulse rate is 120 beats/min and regular, and respirations are 24 breaths/min. Assessment of his left flank reveals ecchymosis. You should:  A) start an IV line of normal saline, administer 1 µg/kg of fentanyl for pain relief, protect his spine, and transport.  B) administer high-flow oxygen, conclude that his heart rate is due to pain, administer 4 mg of morphine IM, and transport.  C) protect his spine, administer high-flow oxygen, transport at once, and establish vascular access en route to the hospital.  D) give high-flow oxygen, start two large-bore IV lines at the scene, administer a 20 mL/kg normal saline bolus, and transport.

Slide 20: 

19. MOST cases of chronic renal failure are caused by:  A) systemic diseases such as diabetes.  B) nephron deterioration due to aging.  C) frequent lower urinary tract infections.  D) nephron destruction due to medications.

Slide 21: 

20. A young woman presents with left-sided flank pain, dysuria, and fever. She tells you that she has been experiencing pain and difficulty with urination for the past week, but did not see her physician. She called 9-1-1 when the flank pain and fever began. This patient is MOST likely experiencing:  A) renal failure.  B) a renal calculus.  C) kidney stones.  D) pyelonephritis.

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