Chapter 25 The Urinary System Flashcards
1
Q
Site at which most of the tubular reabsorption occurs
A
proximal convoluted tubule
2
Q
Site of filtrate formation
A
glomerulus
3
Q
site that drains the distal convoluted tubule
A
collecting duct
4
Q
blood supply that directly receives substances from the tubular cells
A
peritubular capillaries
5
Q
low pressure, porous vessels that reabsorb solutes and water from the tubule cells
A
peritubular capillaries
6
Q
high pressure vessel that forces fluid and solutes into the glomerular capsule
A
afferent arterioles
7
Q
may form meandering vessels or bundles of long straight vessels
A
efferent arterioles
8
Q
play a role in urine concentration
A
vasa recta
9
Q
fenestrated vessels that allow passage of all plasma elements but not blood cells
A
glomerular capillaries
10
Q
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. False, why?
A
False.
11
Q
The path urine takes after it is formed until it leaves the body is the urethra, urinary bladder, and finally the ureter. False, why?
A
Urinary bladder to ureter to urethra
12
Q
Both the male and female urethras serve both the urinary and reproductive systems. False, why?
A
Only male
13
Q
Glomerular filtration is an ATP-driven process. False, why?
A
it is not
14
Q
The collecting duct is impermeable to water in the presence of ADH. False, why?
A
is permeable
15
Q
High blood pressure triggers granular cells of the juxtaglomerular complex to release resin. False, why?
A
False, inhibits
16
Q
Blood pressure in the renal glomerulus is lower than in most parts of the body in order to conserve body water. False, why?
A
bp is higher
17
Q
The proximal convoluted tubule is the portion of the nephron that attaches to the collecting duct. False, why?
A
False, distal convoluted tube
18
Q
The myogenic mechanism reflects the tendency of vascular smooth muscle to stretch. False, why?
A
False, contract
19
Q
An excessive urine output is called anuria. False, why?
A
False, polyuria
20
Q
The trigone is so named because of the shape of the urinary bladder. False, why?
A
False, a smooth triangular area near the bladder
21
Q
The macula densa cells are chemoreceptors that respond to changes in the urea content of the filtrate. False, why?
A
False, solute content of the filtrate
22
Q
Having a kinked ureter is called a renal ptosis. False, why?
A
False, ureterocele is term for kinked ureter
23
Q
Cortical nephrons are responsible for producing concentrated urine. False, why?
A
False, loop of henley
24
Q
Which of the following is the best explanation for why the cells of the proximal convoluted tubule contain so many mitochondria?
A
a great deal of active transport takes place in the PCT
25
What is the best explanation for the microvilli on the apical surface of the proximal convoluted tubule?
They increase the surface area and allow for greater volume of filtrate components to be reabsorbed.
26
The thin segment of the nephron loop's descending limb ________.
aids in the passive movement of water out of the tubule
27
The relatively long half-life of lipid-soluble hormones compared to water soluble hormones is due in part to the way that these hormones are passed into the filtrate from the glomerular capillaries. From the list below, select the best explanation for why lipid soluble hormones have a relatively long half-life.
Steroid hormones travel in the plasma on large transport proteins that cannot pass through the filtration membrane.
28
The presence of protein in the urine indicates which of the following?
damage to the filtration membrane
29
Hydrostatic pressure is the primary driving force of plasma through the filtration membrane into the capsular space. All but one of the following statements reflects why hydrostatic pressure is so high in the glomerular capillaries. Select the one statement that does NOT explain the high pressure within the glomerular capillaries.
The volume of plasma in the efferent arteriole is higher when compared to the afferent arteriole.
30
Cells and transport proteins are physically prevented from passing through the filtration membrane. This has the following effect on filtration.
increasing osmotic pressure in the glomerular capillaries that reduces the amount of filtration
31
If the diameter of the afferent arterioles leasing to the glomerulus increases (vasodilation), which of the following is NOT likely to occur?
systemic blood pressure will go up
32
If the diameter of the efferent arterioles leading away from the glomerulus increases (vasodilation), which of the following is NOT likely to occur?
systemic blood pressure will decrease
33
If the diameter of the afferent arterioles leading to the glomerulus decreases (vasoconstriction), which of the following is NOT likely to occur?
systemic blood pressure will decrease
34
If the diameter of the efferent arterioles leading away from the glomerulus decreases (vasoconstriction), which of the following is NOT likely to occur?
systemic blood pressure will go up.
35
) If the glomerular mesangial cells contract, reducing the overall surface area of the glomerulus which of the following is not likely to occur?
Systemic blood pressure will be lowered.
36
If blood pressure drops very low (MAP is below 80mmHg) renin enzyme will be secreted by granular cells. Which of the following is not likely to occur?
Kidney perfusion will increase
37
Which of the following statements best describes the difference between the intrinsic and extrinsic controls of the kidney?
Extrinsic controls have the greatest effect on systemic blood pressure while intrinsic control have a greater effect on GFR.
38
Reabsorption of nutrients like glucose and amino acids takes place in the proximal convoluted tubule (PCT) via cotransporters that utilize secondary active transport. Which of the following would stop the reabsorption of glucose at the apical surface of the cells in the PCT?
loss of Na+-K+ ATPase in the basolateral surface of PCT cells
39
Bulk flow of nutrients, ions and water into the peritubular capillaries is the result of all of the following except one. Select the answer below that does not describe a cause of bulk flow of fluids into the peritubular capillaries.
leaky tight junctions of peritubular capillary's endothelium
40
The mechanism that establishes the medullary osmotic gradient depends most on the permeability properties of the ________.
) nephron loop
41
Which of the following is not associated with the renal corpuscle?
a vasa recta
42
An increase in the permeability of the cells of the collecting tubule to water is due to a(n) ________.
increase in the production of ADH
43
The urinary bladder is composed of ________ epithelium.
transitional
44
The kidneys are stimulated to produce renin ________.
by a decrease in the blood pressure
45
Which of the choices below is not a function of the urinary system?
eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat
46
The ________ artery lies on the boundary between the cortex and medulla of the kidney.
arcuate
47
The glomerulus differs from other capillaries in the body in that it ________.
is drained by an efferent arteriole
48
) The descending limb of the nephron loop ________.
contains fluid that becomes more concentrated as it moves down into the medulla
49
Select the correct statement about the ureters.
The ureters are capable of peristalsis like that of the gastrointestinal tract
50
The fatty tissue surrounding the kidneys is important because it ________.
stabilizes the position of the kidneys by holding them in their normal position
51
The renal corpuscle is made up of ________.
Bowman's capsule and glomerulus
52
The functional and structural unit of the kidneys is the ________.
nephron
53
Which of the following does not describe the justaglomerular complex?
Its macula densa cells produce aldosterone.
54
The chief force pushing water and solutes out of the blood across the filtration membrane is ________.
glomerular hydrostatic pressure (glomerular blood pressure)
55
Which of the following acts as the trigger for the initiation of micturition (voiding)?
the stretching of the bladder wall
56
The filtration membrane includes all except ________.
renal fascia
57
The mechanism of water reabsorption by the renal tubules is ________.
osmosis
58
The glomerular capsule contains ______.
filtrate
59
The macula densa cells respond to ________.
changes in Na+ content of the filtrate
60
Which of the following is not reabsorbed by the proximal convoluted tubule?
creatinine
61
The fluid in glomerular capsule is similar to plasma except that it does not contain a significant amount of ________.
plasma protein
62
Alcohol acts as a diuretic because it ________.
inhibits the release of ADH
63
The function of angiotensin II is to ________.
constrict arterioles and increase blood pressure
64
An important characteristic of urine is its specific gravity or density, which is ________.
B) slightly higher than water
65
Place the following in correct sequence from the formation of a drop of urine to its elimination from the body.
1. major calyx
2. minor calyx
3. nephron
4. urethra
5. ureter
6. collecting duct
3, 6, 2, 1, 5, 4
66
Select the correct statement about the nephrons
) The parietal layer of the glomerular capsule is simple squamous epithelium.
67
What would happen if the capsular hydrostatic pressure were increased above normal?
Net filtration would decrease.
68
Which of the following is not a part of the juxtaglomerular complex?
podocyte cells
69
Which of the following is incorrect?
the concentration of urine is lower when urine is reduced
70
Reabsorption of high levels of glucose and amino acids in the filtrate is accomplished by ________.
secondary active transport
71
Which of the choices below is a function of the nephron loop?
form a large volume of very dilute urine or a small volume of very concentrated urine
72
What is the effect of antidiuretic hormone on the cells of the collecting duct?
causes aquaporins to be inserted into the apical membranes
73
Which of the following hormones acting on the collecting duct is the most responsible for retaining sodium ions in the blood?
aldosterone
74
The factor favoring filtrate formation at the glomerulus is the ________.
glomerular hydrostatic pressure
75
Glomerular filtration rate can be controlled by manipulating one major variable, which is _____.
glomerular hydrostatic pressure
76
If one says that the clearance value of glucose is zero, what does this mean?
Normally all the glucose is reabsorbed
77
Excretion of dilute urine requires ________.
impermeability of the collecting tubule to water
78
Which of the choices below is not a method by which the cells of the renal tubules can raise blood pH?
by secreting sodium ions
79
In the ascending limb of the nephron loop the ________.
) thick segment moves ions out into interstitial spaces for reabsorption
80
Except for potassium ions, tubular secretion of most unwanted substances occurs in the ________.
proximal convoluted tubule
81
What is the most direct function of the juxtaglomerular apparatus?
help regulate blood pressure and the rate of blood filtration by the kidneys
82
Which of the choices below is the salt level-monitoring part of the nephron?
macula densa
83
Which of the hormones below is responsible for facultative water reabsorption?
ADH
84
Which of the choices below is not a glomerular filtration rate control method?
electrolyte levels
85
Which of the choices below are the most important hormone regulators of electrolyte reabsorption and secretion?
angiotensin II and aldosterone
86
ADH activated water channels called ________ are essential for water reabsorption in the collecting duct
aquaporins
87
The need to get up in the middle of the night to urinate is called ________.
nocturia
88
The area between the ureters and urethra is that is often the location of infection is called the ________ in a bladder
trigone
89
The ________ mechanism is the general tendency of vascular smooth muscle to contract when stretched
myogenic
90
The presence of pus in the urine is a condition called ________.
pyuria
91
Sodium-linked water flow across a membrane not under hormonal control is called ________ water reabsorption.
obligatory
92
Explain how filtration works in the glomerular capillaries.
The glomerular capillaries are fenestrated, allowing fairly large molecules to pass through. The substances must pass through the basement membrane, where they are further selected for size by the filtration slits of the podocytes.
93
List three substances that are abnormal urinary constituents and provide the proper clinical term for such abnormalities.
Abnormal urinary constituents include the following (the clinical term for each is listed in parentheses): glucose (glycosuria), proteins (proteinuria or albuminuria), ketone bodies (ketonuria), hemoglobin (hemoglobinuria), bile pigments (bilirubinuria), erythrocytes (hematuria), and leukocytes (pyuria).
94
Explain the role of aldosterone in sodium and water balance.
Aldosterone targets the distal tubule and collecting duct and enhances sodium ion reabsorption so that very little leaves the body in urine. Aldosterone also causes increased water reabsorption because, as sodium is reabsorbed, water follows it back into the blood.
95
Explain what is meant by the terms cotransport process and transport maximum.
Cotransport process refers to the active transport of one solute "uphill" (against a concentration gradient) coupled to the "downhill" (with a concentration gradient) movement of another during tubular reabsorption. Transport maximum reflects the number of carriers in the renal tubules available to "ferry" a particular substance.
96
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.
Facultative water reabsorption depends on the presence of antidiuretic hormone. In the presence of ADH, the pores of the collecting tubule increase in number and the filtrate loses water by osmosis as it passes through the medullary regions of increasing osmolarity. Consequently, water is conserved and urine becomes concentrated. The water that passes through these regions is reabsorbed by the body in order to prevent dehydration.
97
List and describe three pressures operating at the filtration membrane, and explain how each influences net filtration pressure.
Glomerular hydrostatic pressure is the chief force pushing water and solutes across the filtration membrane. The higher the glomerular hydrostatic pressure, the more filtrate is pushed across the membrane. Colloid osmotic pressure of plasma proteins in the glomerular blood, and capsular hydrostatic pressure exerted by fluids in the glomerular capsule, drive fluids back into the glomerular capillaries. The net filtration pressure equals glomerular hydrostatic pressure minus the sum of colloid osmotic pressure of glomerular blood and capsular hydrostatic pressure
98
What are aquaporins?
Aquaporins are transmembrane proteins that form water-filled pores in water-permeable portions of the convoluted tubules such as the PCT and collecting duct.
99
Freshly voided urine has very little smell, but shortly after voiding it can give off a very strong smell. Why?
Freshly voided urine is relatively sterile but if it is allowed to stand, bacteria begin to metabolize the urea solutes to release ammonia and other smells depending on the person's diet. A fruity smell generally means there is a diabetes problem.
100
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.
The symptoms indicate a kidney stone that has been passed into the ureter. Recommended treatments include be IV therapy to flush the stone out, surgery, or ultrasound waves to shatter the calculi. The usual prognosis is for complete recovery. There is a possibility of kidney stones forming again.
101
What clinical effects would low blood pressure have on the kidneys of a burn patient?
This patient would have a much lower glomerular hydrostatic pressure due to water losses through burned skin and would have a low GFR. This is highly dangerous, leading to failure of the nephron loop to maintain countercurrent flow, flowed by anuria. It is made worse if any muscle is burned and myoglobin in the blood exceeds its transport maximum, resulting in plugging of the tubules and death of the nephron. Often massive fluid transfusions are required to maintain blood volume, high GFR, and dilution of myoglobinuria to avoid catastrophe.
102
Eleven-year-old Harry is complaining of a severe sore throat and gets to stay home from school. His 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.
Harry is showing the symptoms of kidney inflammation. Kidney inflammations usually result from infections either of the lower urinary tract or, in Harry's case, from his earlier infection of a sore throat. Streptococcal infection of the throat can induce anti-streptococcal antibodies that bind to them, depositing immune complexes in the glomerular membranes. The kidney inflammation that primarily involves glomeruli is called glomerulonephritis, and if severe enough can cause permanent renal failure. In post-streptococcal glomerulonephritis, the smoky brown color of urine most commonly represents the leakage of blood cells through the damaged glomerular membrane.
103
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?
Proteinuria is a condition in which the permeability of the glomerular capillaries is increased to such an extent that large amounts of plasma proteins (mostly albumin) pass into the glomerular filtrate and are excreted in the urine. If the condition is severe, the loss of plasma proteins may decrease osmotic pressure substantially. When this happens there is a tendency for fluid to leave the systemic blood vessels and enter the tissue space. This is the reason for Ellen's swollen limbs.
104
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?
It is possible that Rachael has cystitis, a condition in which the mucous membrane lining the bladder becomes swollen and bleeding occurs. This condition is caused by bacterial invasion of the bladder or by chemical or mechanical irritation. Burning on urination alone implies urethritis — inflammation of the urethra alone, but urinary frequency suggests the bladder itself is also involved, with the inflammation causing smooth muscle irritability lowering the stretch trigger point for micturition.
105
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?
Escherichia coli are normal residents of the digestive tract and generally cause no problems there, but these bacteria account for 80% of all urinary tract infections. The nurse can instruct the patient on proper hygiene measures, including wiping from front to back following urination to avoid introduction of anal bacteria, reduction in sexual activity if sexually active, and increased fluid intake to increase flushing of the urethra. The nurse should also explain that sexually transmitted infections can also inflame the urinary tract, clogging some of its ducts.
106
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.
: Stress incontinence is found most commonly in women with relaxed pelvic musculature deprived of estrogen. Stress incontinence may occur with a sudden increase in intra-abdominal pressure such as coughing or sneezing, which forces urine through the external sphincter. Aging, multiple pregnancies, and obesity are risk factors in increasing the relaxation and/or pressure from above.
107
Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective as an antihypertensive.
Angiotensin II is a potent vasoconstrictor activating smooth muscle of arterioles throughout the body, causing mean arterial blood pressure to rise. ACE inhibitors reduce blood pressure by interrupting the renin-angiotensin-aldosterone system.
