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Question 1. Which part of the nephron is the primary site of glomerular filtration? A) Proximal tubule B) Loop of Henle C) Bowman’s capsule D) Distal tubule Answer: C Explanation: Bowman’s capsule encloses the glomerulus where filtration of plasma occurs. Question 2. The hormone most directly responsible for increasing water reabsorption in the collecting duct is: A) Aldosterone B) Antidiuretic hormone (ADH) C) Renin D) Angiotensin II Answer: B Explanation: ADH inserts aquaporin‑2 channels into the collecting‑duct epithelium, allowing water reabsorption. Question 3. A rise in plasma oncotic pressure will most likely cause which change in glomerular filtration rate (GFR)? A) Increase B) Decrease C) No change D) Variable depending on renal blood flow Answer: B Explanation: Higher oncotic pressure opposes filtration, reducing GFR. Question 4. Which of the following is the most accurate indicator of renal function? A) Blood urea nitrogen (BUN) B) Serum creatinine C) Urine specific gravity D) Urine pH Answer: B Explanation: Serum creatinine correlates closely with glomerular filtration rate. Question 5. In the assessment of urinary elimination, nocturia is defined as: A) Urination >8 times/day B) Urination ≥1 time/night C) Involuntary leakage during sleep D) Urinary retention at night
Answer: B Explanation: Nocturia is waking to void one or more times during the night. Question 6. Costovertebral angle (CVA) tenderness most commonly indicates pathology of which organ? A) Bladder B) Urethra C) Kidney D) Prostate Answer: C Explanation: CVA tenderness suggests renal inflammation or infection. Question 7. Which urinary finding is most characteristic of a urinary tract infection? A) Glucose B) Nitrites C) Bile pigments D) Ketones Answer: B Explanation: Many uropathogens reduce nitrate to nitrite, detectable on dipstick. Question 8. A patient’s urine specific gravity of 1.010 suggests: A) Highly concentrated urine B) Dilute urine C) Normal concentration D) Presence of protein Answer: B Explanation: Values near 1.010 indicate dilute urine, often seen with excess fluid intake. Question 9. Which diuretic acts on the thick ascending limb of the loop of Henle? A) Hydrochlorothiazide B) Furosemide C) Spironolactone D) Metolazone Answer: B Explanation: Loop diuretics like furosemide inhibit Na⁺‑K⁺‑2Cl⁻ transport in that segment. Question 10. The primary mechanism of action of antimuscarinic agents (e.g., oxybutynin) in overactive bladder is:
Explanation: IVP uses iodinated contrast to outline the renal pelvis and ureters. Question 15. The most appropriate nursing action when inserting an indwelling Foley catheter is to: A) Apply a tourniquet B) Use sterile gloves and drape C) Lubricate with alcohol D) Insert the catheter without a guidewire Answer: B Explanation: Aseptic technique with sterile gloves and drape prevents catheter‑associated infection. Question 16. Which of the following is a common side effect of loop diuretics? A) Hyperkalemia B) Hypocalcemia C) Metabolic alkalosis D) Hyponatremia Answer: C Explanation: Loop diuretics increase distal sodium delivery, promoting H⁺ secretion and metabolic alkalosis. Question 17. The hormone aldosterone primarily acts on which nephron segment? A) Proximal tubule B) Loop of Henle C) Distal tubule and collecting duct D) Bowman’s capsule Answer: C Explanation: Aldosterone increases Na⁺ reabsorption and K⁺ secretion in the distal nephron. Question 18. Which of the following best describes the micturition reflex? A) Voluntary contraction of the external sphincter B) Sympathetic inhibition of bladder contraction C) Parasympathetic stimulation of detrusor muscle D) Somatic control of pelvic floor muscles Answer: C Explanation: Parasympathetic fibers (S2‑S4) trigger detrusor contraction during voiding. Question 19. In a patient with diabetes, glycosuria is most likely due to:
A) Decreased GFR B) Renal tubular damage C) Plasma glucose exceeding the renal threshold D) Excess ADH secretion Answer: C Explanation: When plasma glucose surpasses the renal threshold (~180 mg/dL), it appears in urine. Question 20. The most reliable sign of bladder outlet obstruction on physical exam is: A) Palpable suprapubic mass B) Costovertebral angle tenderness C) Decreased skin turgor D) Orthostatic hypotension Answer: A Explanation: A full bladder feels as a suprapubic mass when outflow is obstructed. Question 21. Which stone composition is most strongly associated with hyperparathyroidism? A) Uric acid B) Cystine C) Calcium oxalate D) Struvite Answer: C Explanation: Elevated calcium from hyperparathyroidism predisposes to calcium‑oxalate calculi. Question 22. Phenazopyridine is used primarily to: A) Treat bacterial infection B) Relieve dysuria pain C) Reduce stone size D) Increase urine output Answer: B Explanation: Phenazopyridine is a urinary analgesic that alleviates burning and urgency. Question 23. A 2‑year‑old child is beginning to show interest in using the toilet. This milestone reflects progress in which developmental domain? A) Cognitive B) Gross motor C) Social‑emotional D) Fine motor Answer: C Explanation: Toilet training involves self‑care and social‑emotional independence.
Answer: B Explanation: Thiazides reduce urinary calcium loss, useful in calcium‑stone prevention. Question 29. A positive nitrite test on dipstick indicates the likely presence of: A) Gram‑positive cocci B) Gram‑negative rods C fungi D) Parasites Answer: B Explanation: Many gram‑negative uropathogens reduce nitrate to nitrite. Question 30. Which type of urinary catheter is most appropriate for long‑term drainage in a male patient with neurogenic bladder? A) Intermittent (straight) catheter B) Foley (indwelling) catheter C) Suprapubic catheter D) Condom catheter Answer: C Explanation: Suprapubic catheters reduce urethral trauma and are suitable for chronic use. Question 31. In the renal handling of glucose, the transport maximum (Tm) is reached at a plasma glucose level of approximately: A) 80 mg/dL B) 180 mg/dL C) 250 mg/dL D) 400 mg/dL Answer: B Explanation: Above ~180 mg/dL, glucose exceeds reabsorptive capacity, resulting in glucosuria. Question 32. Which of the following is a common side effect of anticholinergic therapy for overactive bladder? A) Dry mouth B) Hypertension C) Bradycardia D) Hyperglycemia Answer: A Explanation: Anticholinergics decrease secretions, causing xerostomia.
Question 33. The most likely cause of a “cloudy” urine sample with a pH of 5.0 in a young woman is: A) Hematuria B) Bacterial vaginosis C) Urinary tract infection D) Myoglobinuria Answer: C Explanation: Infection often produces acidic, cloudy urine due to leukocytes and bacteria. Question 34. Which of the following best describes the role of the renal papilla? A) Site of glomerular filtration B) Collection point for urine before it enters the minor calyx C) Production of renin D) Reabsorption of sodium Answer: B Explanation: The papilla drains urine from the collecting ducts into the minor calyces. Question 35. A patient with a urinary catheter develops sudden flank pain, fever, and chills. The most likely diagnosis is: A) Catheter blockage B) Acute pyelonephritis C) Bladder spasm D) Urethral trauma Answer: B Explanation: Fever and flank pain suggest upper urinary tract infection (pyelonephritis). Question 36. Which of the following best characterizes a “mixed” urinary incontinence pattern? A) Only stress symptoms B) Only urge symptoms C) Both stress and urge symptoms D) Only functional symptoms Answer: C Explanation: Mixed incontinence includes elements of both stress and urge types. Question 37. In a urinalysis, a urine pH of 8.0 is most commonly associated with: A) Metabolic acidosis B) Uric acid stones C) Struvite stones D) Calcium oxalate stones
Question 42. The presence of “candle‑wax” deposits on the bladder wall on cystoscopy suggests: A) Chronic cystitis B) Schistosomiasis C) Interstitial cystitis D) Transitional cell carcinoma Answer: B Explanation: Schistosoma haematobium infection produces characteristic calcified granulomas. Question 43. Which of the following is the most appropriate intervention for a patient with functional incontinence? A) Pelvic floor exercises B) Scheduled toileting and environmental modifications C) Anticholinergic medication D) Catheterization Answer: B Explanation: Functional incontinence is addressed by removing barriers to timely toileting. Question 44. In the renal clearance equation, clearance (C) equals: A) (Urine concentration × Urine flow rate) / Plasma concentration B) Plasma concentration / Urine concentration C) Urine flow rate / Plasma concentration D) (Plasma concentration × Urine flow rate) / Urine concentration Answer: A Explanation: Clearance = (U × V) / P, where U = urine concentration, V = flow rate, P = plasma concentration. Question 45. Which electrolyte disturbance is most commonly seen with loop diuretic therapy? A) Hypernatremia B) Hyperkalemia C) Hypocalcemia D) Hypermagnesemia Answer: C Explanation: Loop diuretics increase calcium excretion, leading to hypocalcemia.
Question 46. A patient with a newly placed suprapubic catheter reports lower abdominal pain and a foul‑smelling drainage bag. The most likely problem is: A) Catheter kink B) Infection of the catheter tract C) Bladder spasm D) Over‑distended bladder Answer: B Explanation: Suprapubic catheter sites are prone to infection, causing pain and odor. Question 47. Which of the following best describes the effect of vasopressin (ADH) on the vasa recta? A) Vasoconstriction to reduce renal blood flow B) Vasodilation to increase medullary blood flow C) No direct effect D) Increases glomerular hydrostatic pressure Answer: C Explanation: ADH primarily acts on collecting‑duct cells; it has minimal direct effect on vasa recta tone. Question 48. In a urine dipstick, a positive result for bilirubin most likely indicates: A) Hemolysis B) Liver disease with conjugated hyperbilirubinemia C) Renal tubular necrosis D) Dehydration Answer: B Explanation: Only conjugated bilirubin is water‑soluble and appears in urine. Question 49. Which of the following is the primary function of the macula densa? A) Filtrate reabsorption B) Sensing tubular NaCl concentration to regulate renin release C) Secreting aldosterone D) Producing erythropoietin Answer: B Explanation: The macula densa detects NaCl and modulates renin secretion via the tubuloglomerular feedback.
A) Strengthen the pelvic floor B) Increase bladder capacity and improve voluntary control C) Reduce urine output D) Promote diuresis Answer: B Explanation: Scheduled voiding lengthens intervals, teaching the brain to delay urgency. Question 55. Which of the following best describes the effect of pregnancy on GFR? A) Decreases by 20% B) Remains unchanged C) Increases by up to 50% D) Fluctuates wildly without pattern Answer: C Explanation: Increased plasma volume and renal blood flow raise GFR during pregnancy. Question 56. A urine sample shows a specific gravity of 1.005, pH 6.5, and no protein. Which condition is this most consistent with? A) Diabetes insipidus B Answer: A Explanation: Very dilute urine (low specific gravity) suggests inability to concentrate urine, as seen in diabetes insipidus. Question 57. Which of the following best explains why nocturnal enuresis is common in children under five years old? A) Low bladder capacity B) Immature antidiuretic hormone secretion C) High dietary sodium intake D) Overactive bladder muscles Answer: B Explanation: The circadian rhythm of ADH secretion is not fully developed, leading to night‑time polyuria.
Question 58. In assessing a patient with suspected renal colic, the most appropriate immediate intervention is: A) Administering a high‑dose diuretic B) Providing NSAID analgesia and hydration C) Initiating dialysis D) Inserting a Foley catheter Answer: B Explanation: NSAIDs reduce ureteral spasm and pain; hydration facilitates stone passage. Question 59. Which of the following best describes the mechanism of action of bethanechol? A) Muscarinic receptor antagonist B) Muscarinic receptor agonist C) Alpha‑adrenergic blocker D) Beta‑adrenergic agonist Answer: B Explanation: Bethanechol stimulates muscarinic receptors, enhancing detrusor contraction for urinary retention. Question 60. A 68‑year‑old man with BPH reports a weak urinary stream and nocturia. Which laboratory test is most useful to assess renal function in this patient? A) Urine dipstick for protein B) Serum creatinine C) Urine specific gravity D) Serum calcium Answer: B Explanation: Serum creatinine reflects glomerular filtration and is essential in evaluating renal status. Question 61. Which of the following is the most common cause of sterile pyuria (white cells in urine without bacterial growth)? A) Viral infection B) Tuberculosis of the urinary tract C) Interstitial cystitis D) Fungal infection Answer: C Explanation: Interstitial cystitis produces inflammation with leukocytes but no bacterial growth.
Question 66. In a urinalysis, the presence of “cottage‑cheese” clumps is most suggestive of: A) Calcium oxalate stones B) Urate crystals C) Struvite (magnesium‑ammonium‑phosphate) crystals D) Cystine crystals Answer: C Explanation: Struvite crystals appear as coarse, irregular, often “cottage‑cheese” aggregates. Question 67. Which medication class is contraindicated in patients with narrow‑angle glaucoma when used for overactive bladder? A) β‑blockers B) Anticholinergics C) Loop diuretics D) ACE inhibitors Answer: B Explanation: Anticholinergics can increase intra‑ocular pressure, worsening glaucoma. Question 68. The most common cause of painless gross hematuria in adults is: A) Bladder cancer B) Acute cystitis C) Urolithiasis D) Renal papillary necrosis Answer: A Explanation: Bladder carcinoma often presents with painless blood in urine. Question 69. A patient with chronic kidney disease is prescribed erythropoietin‑stimulating agents. The primary purpose of this therapy is to: A) Increase GFR B) Reduce proteinuria C) Treat anemia of renal failure D) Lower serum phosphorus Answer: C Explanation: CKD reduces erythropoietin production, leading to anemia; supplementation corrects it. Question 70. Which of the following best describes the effect of a high‑sodium diet on urinary calcium excretion? A) Decreases calcium excretion B) Increases calcium excretion C) No effect D) Converts calcium to oxalate
Answer: B Explanation: Sodium and calcium share transport; excess sodium promotes calcium loss in urine. Question 71. In a patient with neurogenic bladder, which of the following interventions is most appropriate to prevent urinary retention? A) Encourage fluid restriction B) Perform intermittent catheterization as scheduled C) Use a Foley catheter permanently D) Administer anticholinergics Answer: B Explanation: Clean intermittent catheterization empties the bladder regularly, preventing retention. Question 72. Which of the following best explains why a low‑dose thiazide diuretic is used in the management of calcium kidney stones? A) It raises urinary citrate B) It reduces urinary calcium excretion C) It alkalinizes urine D) It increases urine volume dramatically Answer: B Explanation: Thiazides decrease calcium excretion, lowering stone formation risk. Question 73. A 55‑year‑old woman presents with urgency, frequency, and nocturia. Urinalysis is negative for infection. The most likely diagnosis is: A) Stress incontinence B) Overactive bladder (urge incontinence) C) Overflow incontinence D) Functional incontinence Answer: B Explanation: Symptoms without infection suggest urge (overactive) incontinence. Question 74. Which of the following is the most accurate method for measuring urine output in an adult patient? A) Visual estimation B) Weighing the collection bag C) Using a calibrated container D) Measuring bladder pressure
Question 79. Which of the following is the most common type of stone in patients with hyperuricemia? A) Calcium oxalate B) Struvite C) Cystine D) Uric acid Answer: D Explanation: Elevated uric acid precipitates as uric acid stones, especially in acidic urine. Question 80. In the management of acute pyelonephritis, the initial antibiotic of choice for an outpatient with no resistance concerns is: A) Nitrofurantoin B) Ciprofloxacin C) Vancomycin D) Trimethoprim‑sulfamethoxazole Answer: B Explanation: Fluoroquinolones achieve high renal tissue concentrations and are oral. Question 81. The most reliable clinical sign of bladder over‑distension is: A) Palpable suprapubic mass B) Costovertebral angle tenderness C) Decreased skin turgor D) Elevated BUN Answer: A Explanation: A full bladder can be felt as a firm suprapubic mass. Question 82. Which of the following best describes the effect of a high‑protein, low‑carbohydrate diet on urine pH? A) Makes urine more alkaline B) Makes urine more acidic C) No effect on urine pH D) Causes urine pH to fluctuate wildly Answer: B Explanation: Metabolism of protein generates acid (e.g., sulfuric acid), lowering urine pH.
Question 83. A 3‑month‑old infant presents with a palpable bladder and urinary stream that dribbles. The most likely diagnosis is: A) Posterior urethral valves B) Vesicoureteral reflux C) Hypospadias D) Neurogenic bladder Answer: A Explanation: Posterior urethral valves cause obstruction in male infants, leading to bladder distention. Question 84. Which of the following lab values would most strongly suggest a pre‑renal cause of acute kidney injury? A) BUN/creatinine ratio >20:1 B) Fractional excretion of sodium >2% C) Urine osmolality <300 mOsm/kg D) Presence of granular casts Answer: A Explanation: Elevated BUN/Cr ratio indicates reduced perfusion (pre‑renal). Question 85. The primary purpose of a condom catheter in male patients is to: A) Provide continuous drainage without urethral instrumentation B) Replace a Foley catheter permanently C) Treat urinary retention D) Deliver medication directly to the bladder Answer: A Explanation: Condom catheters collect urine externally, avoiding urethral catheterization. Question 86. Which of the following best explains why elderly patients often develop urge incontinence? A) Increased bladder capacity B) Diminished detrusor contractility C) Decreased sensation of bladder fullness D) Overactive detrusor muscle due to age‑related changes Answer: D Explanation: Age‑related detrusor overactivity leads to involuntary contractions and urgency.
