Pathophysiology Chapter 40 Alterations of Renal and Urinary Tract Function in Children

Chapter 40: Alterations of Renal and Urinary Tract Function in Children

MULTIPLE CHOICE

1.            The functional kidney is associated with which embryonic organ?

a.            Metanephros

b.            Mesonephros

c.             Pronephros

d.            Endonephros

2.            When does urine formation and excretion begin?

a.            At birth

b.            By 3 months’ gestation

c.             By 6 months’ gestation

d.            By 8 months’ gestation

3.            Compared with an adult, an infant has a greater content of extracellular fluid, as well as a greater rate of fluid exchange. What effect does this have on the fluid balance of a child compared with that of an adult?

a.            Edema development is less of a problem.

b.            Overhydration is not difficult to manage.

c.             Daily fluid requirements are greater.

d.            The control of dehydration is more difficult.

4.            What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis?

a.            Hypospadias

b.            Epispadias

c.             Hyperspadias

d.            Chordee

5.            What initiates inflammation in acute poststreptococcal glomerulonephritis?

a.            Lysosomal enzymes

b.            Endotoxins from Streptococcus

c.             Immune complexes

d.            Immunoglobulin E (IgE)–mediated response

6.            Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria?

a.            Staphylococcus aureus

b.            Streptococcus

c.             Pseudomonas aeruginosa

d.            Haemophilus

7.            A child with acute poststreptococcal glomerulonephritis is voiding smoky, brown-colored urine and asks the healthcare professional to explain what causes it. What explanation by the professional is best?

a.            Presence of red blood cells

b.            Presence of urobilinogen

c.             Slough from the collecting tubules

 d.           Protein in the urine

8.            In immunoglobulin G (IgG) nephropathies such as glomerulonephritis, IgG is deposited in which location?

a.            Juxtamedullary nephrons

b.            Glomerulus basement membranes

c.             Mesangium of the glomerular capillaries

d.            Parietal epithelium

9.            What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic- uremic syndrome (HUS)?

a.            Immunoglobulin A (IgA) coats erythrocytes that are destroyed by the spleen, and remnants are excreted through the kidneys.

b.            Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells.

c.             Endotoxins from E. coli block the erythropoietin produced by the kidneys, which reduces the number of erythrocytes produced by the bone marrow.

d.            Failure of the nephron to filter urea increases the blood urea nitrogen, which binds to erythrocytes that are subsequently destroyed by the spleen.

10.          What is the first indication of nephrotic syndrome in children?

a.            Periorbital edema

b.            Scrotal or labial edema

c.             Frothy urine

d.            Ascites

11.          Bacteria gain access to the female urinary tract by which means?

a.            Systemic blood that is filtered through the kidney

b.            Bacteria traveling from the lymph adjacent to the bladder and kidneys

c.             Bacteria ascending the urethra into the bladder

d.            Colonization of the bladder when urine is static

12.          What causes vesicoureteral reflux to occur in children?

a.            Children do not ask for help in urinating in a timely manner, and urine is forced up into the ureters.

b.            The submucosal segment of a child’s ureter is short, making the antireflux mechanism inefficient.

c.             The trigone lying between the opening to the ureters and the urethra is underdeveloped in children.

d.            As the bladder fills in infants and children, it pulls the smooth lining of the transitional epithelium away from the ureters, making the reflux valves ineffective.

13.          What is the mechanism for developing Wilms tumor?

a.            It involves tumor-suppressor genes located on chromosome 11.

b.            Development involves an autosomal dominant inheritance pattern.

c.             Wilms tumor is an autoimmune disorder.

d.            The development of a Wilms tumor is a congenital anomaly.

14.          Which anomaly is often associated with Wilms tumor?

a.            Renal anaplasia

b.            Aniridia

c.             Anemia

d.            Hypothyroidism

15.          A healthcare professional has taught a parent group about the causes of enuresis. What statement by a parent indicates the professional needs to give more information?

a.            A maturational lag may cause enuresis.

b.            Enuresis may be related to increased light sleep.

c.             Obstructive sleep apnea may be a symptom of enuresis.

d.            Elevated nocturnal levels of vasopressin may cause enuresis.

16.          When does an individual have their full complement of renal nephrons?

a.            At birth

b.            At 6 months of age

c.             At puberty

d.            Between the ages 18 and 21 years

MULTIPLE RESPONSE

1.            Which statements are true regarding the narrow chemical safety margin that infants demonstrate?

(Select all that apply.)

a.            The immaturity of tubules may diminish the response to antidiuretic hormone

(ADH).

 b.           An immature tubular transport capacity impairs the excretion of potassium.

c.             An immature tubular transport capacity impairs the reabsorption of bicarbonate.

d.            The immaturity of tubules may diminish the response to aldosterone.

e.            The safety margin begins to expand after 2 years of age.

2.            The excretion of urea is low in infants because of which features? (Select all that apply.)

a.            Medullary nephrons with comparatively short loops

b.            Immature tubular transport capacity impairing the excretion of urea

c.             High anabolic state

d.            Dilute urine as a result of the immaturity of an infant’s glomeruli

e.            Available protein used for physical growth

3.            Which factors are involved in the development of hypospadias? (Select all that apply.)

a.            Disruption in male hormones, including testosterone

b.            Mutation of gene HP-1 (chromosome 16)

c.             5?-reductase mutations

d.            Hormones administered for in vitro fertilization

e.            Advanced maternal age

.               Which cells of the inflammatory process are found in acute poststreptococcal glomerulonephritis? (Select all that apply.)

a.            Immunoglobulin G (IgG)

b.            Immunoglobulin A (IgA)

c.             Complement C3

d.            Immunoglobulin E (IgE)

 e.           Immune complexes

5.            Which symptoms are considered part of the nephrotic syndrome in children? (Select all that apply.)

a.            Proteinuria

b.            Pyuria

c.             Hyperlipidemia

d.            Edema

e.            Hypoalbuminemia

6.            What information does the student learn about hemolytic uremic syndrome (HUS)? (Select all that apply.)

a.            Microangiopathic hemolytic anemia characterizes HUS.

b.            Thrombocytopenia is a comorbid condition.

c.             Wilms tumors are often the trigger for HUS.

d.            Most common community-acquired cause of acute renal failure in young children.

e.            HUS is chronic in nature.

7.            What problems are commonly associated with the diagnosis of horseshoe kidneys? (Select all that apply.)

a.            Hydronephrosis

b.            Nephritis

c.             Infection

d.            Kidney stones

e.            Pyuria

8.            Which structural anomalies are associated with urinary tract malformations? (Select all that apply.)

a.            Low-set ears

b.            Prune-belly syndrome

c.             Broad-bridged nose

d.            Imperforate anus

e.            Malformed lips