Anatomy & Physiology ch 25
Anatomy & Physiology ch 25 Biol 2301
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Human Anatomy & Physiology, 8e (Marieb/Hoehn) Chapter 25 The Urinary System Matching Questions Figure 25.1 Using Figure 25.1, match the following: 1) Glomerulus. Answer: C Diff: 1 Page Ref: 967; Fig. 25.7a 2) Afferent arteriole. Answer: A Diff: 1 Page Ref: 967; Fig. 25.7a 3) Collecting duct. Answer: B Diff: 1 Page Ref: 967; Fig. 25.7a 4) Loop of Henle. Answer: E Diff: 1 Page Ref: 967; Fig. 25.7a 5) Peritubular capillaries. 1 Copyright © 2010 Pearson Education, Inc. Answer: D Diff: 1 Page Ref: 964; Fig. 25.7a 6) Structure most closely associated with granular cells. Answer: A Diff: 1 Page Ref: 966; Fig. 25.7a 7) Medulla of the kidney. Answer: E Diff: 1 Page Ref: 966; Fig. 25.7a Figure 25.2 Using Figure 25.2, match the following: 8) Podocyte. Answer: B Diff: 1 Page Ref: 970; Fig. 25.9 9) Is composed of simple squamous epithelium. Answer: A Diff: 1 Page Ref: 964; Fig. 25.7 2 Copyright © 2010 Pearson Education, Inc. 10) Collecting duct cells. Answer: C Diff: 1 Page Ref: 965; Fig. 25.5 11) Proximal convoluted tubule cells. Answer: E Diff: 1 Page Ref: 965; Fig. 25.5 12) Filtrate at the site of these cells is about the same osmolarity as blood plasma. Answer: E Diff: 2 Page Ref: 966; Fig. 25.5 13) Cells that are the most active in reabsorbing the filtrate. Answer: E Diff: 2 Page Ref: 966; Fig. 25.5 14) Cells that reabsorb virtually all the nutrients. Answer: E Diff: 2 Page Ref: 966; Fig. 25.5 15) Cells that are most affected by ADH. Answer: C Diff: 3 Page Ref: 966; Fig. 25.5 16) Almost no water is absorbed in these cells. Answer: D Diff: 3 Page Ref: 966; Fig. 25.5 Match the following: A) Site at which most of the tubular reabsorption occurs. B) Blood supply that directly receives substances from the tubular cells. C) Site of filtrate formation. D) Site that drains the distal convoluted tubule. 17) Proximal convoluted tubule. Diff: 1 Page Ref: 966, 974 18) Glomerulus. Diff: 1 Page Ref: 969 19) Peritubular capillaries. Diff: 2Page Ref: 968 3 Copyright © 2010 Pearson Education, Inc. 20) Collecting duct. Diff: 2 Page Ref: 966 Answers: 17) A 18) C 19) B 20) D 4 Copyright © 2010 Pearson Education, Inc. True/False Questions 1) 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. Answer: FALSE Diff: 2 Page Ref: 972 2) In the kidneys, the countercurrent mechanism involves the interaction between the flow of filtrate through the loop of Henle of the juxtamedullary nephrons (the countercurrent multiplier) and the flow of blood through the limbs of adjacent blood vessels (the countercurrent exchanger). This relationship establishes and maintains an osmotic gradient extending from the cortex through the depths of the medulla that allows the kidneys to vary urine concentration dramatically. Answer: TRUE Diff: 3 Page Ref: 979982 3) The ureter transports urine from the kidney to the urinary bladder. Answer: TRUE Diff: 1 Page Ref: 985 4) Water reabsorption through the proximal convoluted tubule is termed obligatory water reabsorption, whereas water reabsorption through the distal convoluted tubule is termed facultative water reabsorption. Answer: TRUE Diff: 2 Page Ref: 975, 978 5) The position of the kidneys behind the peritoneal lining of the abdominal cavity is described by the term retroperitoneal. Answer: TRUE Diff: 1 Page Ref: 961 6) The entire responsibility for urine formation lies with the nephron. Answer: TRUE Diff: 1 Page Ref: 964 7) Urine is 95% water by volume. Answer: TRUE Diff: 1 Page Ref: 985 8) The act of emptying the bladder is called voiding. Answer: TRUE Diff: 1 Page Ref: 988 9) Glomerular filtration is an ATPdriven process. Answer: FALSE 5 Copyright © 2010 Pearson Education, Inc. Diff: 1 Page Ref: 969 10) In the absence of hormones, the distal tubule and collecting ducts are relatively impermeable to water. Answer: TRUE Diff: 1 Page Ref: 978 11) The collecting duct is impermeable to water in the presence of ADH. Answer: FALSE Diff: 1 Page Ref: 978 12) The urethra contains an internal sphincter of smooth muscle. Answer: TRUE Diff: 1 Page Ref: 987 13) Angiotensin II is a substance made by the body to lower blood pressure during stress. Answer: FALSE Diff: 1 Page Ref: 974 14) Aldosterone is a hormone that causes the renal tubules to reclaim sodium ions from the filtrate. Answer: TRUE Diff: 1 Page Ref: 978 15) Blood pressure in the renal glomerulus is lower than in most parts of the body in order to conserve body water. Answer: FALSE Diff: 1 Page Ref: 969 16) The proximal convoluted tubule is the portion of the nephron that attaches to the collecting duct. Answer: FALSE Diff: 1 Page Ref: 966 17) Urea is reabsorbed in the loop of Henle. Answer: FALSE Diff: 1 Page Ref: 976978 18) Incontinence is the inability to control voluntary micturition. Answer: TRUE Diff: 1 Page Ref: 988 19) The myogenic mechanism reflects the tendency of vascular smooth muscle to stretch. Answer: FALSE Diff: 2 Page Ref: 972 6 Copyright © 2010 Pearson Education, Inc. 20) An excessive urine output is called anuria. Answer: FALSE Diff: 2 Page Ref: 974 21) Tubular secretion is effective in controlling blood pH. Answer: TRUE Diff: 2 Page Ref: 978 22) The trigone is so named because of the shape of the urinary bladder. Answer: FALSE Diff: 2 Page Ref: 986 23) Atrial naturetic peptide inhibits sodium reabsorption. Answer: TRUE Diff: 3 Page Ref: 974 24) The macula densa cells are chemoreceptors that respond to changes in the urea content of the filtrate. Answer: FALSE Diff: 1 Page Ref: 968969 25) Blood in the urine may be a symptom of bladder cancer. Answer: TRUE Diff: 2 Page Ref: 985; Tbl. 25.2 26) Obligatory water reabsorption involves the movement of water along an osmotic gradient. Answer: TRUE Diff: 3 Page Ref: 975 27) Having a kinked ureter is called renal ptosis. Answer: FALSE Diff: 3 Page Ref: 961 7 Copyright © 2010 Pearson Education, Inc. MultipleChoice Questions 1) The mechanism that establishes the medullary osmotic gradient depends most on the permeability properties of the ________. A) loop of Henle B) glomerular filtration membrane C) collecting duct D) distal convoluted tubule Answer: A Diff: 2 Page Ref: 980; Fig. 25.16 2) Urine passes through the ________. A) renal hilum to the bladder to the ureter B) pelvis of the kidney to ureter to bladder to urethra C) glomerulus to ureter to renal tubule D) hilum to urethra to bladder Answer: B Diff: 1 Page Ref: 962 3) Which of the following is not associated with the renal corpuscle? A) a podocyte B) a vasa recta C) a fenestrated capillary D) an efferent arteriole Answer: B Diff: 1 Page Ref: 964968 4) An increase in the permeability of the cells of the collecting tubule to water is due to a(n) ________. A) decrease in the production of ADH B) increase in the production of ADH C) increase in the production of aldosterone D) decrease in the concentration of the blood plasma Answer: B Diff: 1 Page Ref: 981 5) The urinary bladder is composed of ________ epithelium. A) transitional B) simple squamous C) stratified squamous D) pseudostratified columnar Answer: A Diff: 1 Page Ref: 986 8 Copyright © 2010 Pearson Education, Inc. 6) The kidneys are stimulated to produce renin ________. A) when the peritubular capillaries are dilated B) when the pH of the urine decreases C) by a decrease in the blood pressure D) when the specific gravity of urine rises above 1.10 Answer: C Diff: 1 Page Ref: 971974 7) Which of the choices below is not a function of the urinary system? A) helps maintain homeostasis by controlling the composition, volume, and pressure of blood B) regulates blood glucose levels and produces hormones C) maintains blood osmolarity D) eliminates solid, undigested wastes and excretes carbon dioxide, water, salts, and heat Answer: D Diff: 1 Page Ref: 960961 8) Which gland sits atop each kidney? A) adrenal B) thymus C) pituitary D) pancreas Answer: A Diff: 1 Page Ref: 961 9) The ________ artery lies on the boundary between the cortex and medulla of the kidney. A) lobar B) arcuate C) interlobar D) cortical radiate Answer: B Diff: 1 Page Ref: 963 10) The glomerulus differs from other capillaries in the body in that it ________. A) has a basement membrane B) is impermeable to most substances C) is drained by an efferent arteriole D) has a blood pressure much lower than other organ systems Answer: C Diff: 1 Page Ref: 966, 968 11) The descending limb of the loop of Henle ________. A) is not permeable to water B) is freely permeable to sodium and urea C) pulls water by osmosis into the lumen of the tubule D) contains fluid that becomes more concentrated as it moves down into the medulla 9 Copyright © 2010 Pearson Education, Inc. Answer: D Diff: 2 Page Ref: 966, 976977 12) Select the correct statement about the ureters. A) Ureters contain sphincters at the entrance to the bladder to prevent the backflow of urine. B) The epithelium is stratified squamous like the skin, which allows a great deal of stretch. C) The ureters are capable of peristalsis like that of the gastrointestinal tract. D) The ureter is innervated by parasympathetic nerve endings only. Answer: C Diff: 1 Page Ref: 985986 13) The fatty tissue surrounding the kidneys is important because it ________. A) ensures adequate energy for the adrenal glands to operate efficiently B) stabilizes the position of the kidneys by holding them in their normal position C) is necessary as a barrier between the adrenal glands and kidneys D) produces vitamin D Answer: B Diff: 1 Page Ref: 961 14) The renal corpuscle is made up of ________. A) Bowman's capsule and glomerulus B) the descending loop of Henle C) the renal pyramid D) the renal papilla Answer: A Diff: 1 Page Ref: 964 15) The functional and structural unit of the kidneys is the ________. A) nephron B) loop of Henle C) glomerular capsule D) basement membrane of the capillaries Answer: A Diff: 1 Page Ref: 964 16) The juxtaglomerular apparatus is responsible for ________. A) the secretion of drugs B) the secretion of acids and ammonia C) reabsorption of organic molecules, vitamins, and water D) regulating the rate of filtrate formation and controlling systemic blood pressure Answer: D Diff: 1 Page Ref: 968 10 Copyright © 2010 Pearson Education, Inc. 17) The chief force pushing water and solutes out of the blood across the filtration membrane is ________. A) the design and size of the podocytes B) the thickness of the capillary endothelium C) glomerular hydrostatic pressure (glomerular blood pressure) D) the size of the pores in the basement membrane of the capillaries Answer: C Diff: 1 Page Ref: 971 18) Which of the following statements describes the histology of the ureters? A) They are trilayered (mucosa, muscularis, and adventitia). B) They are actually an extension of the visceral peritoneum. C) They are made up of several layers of endothelium. D) They are made up entirely of muscle tissue because they need to contract in order to transport urine efficiently. Answer: A Diff: 1 Page Ref: 986 19) Which of the following statements is a false or incorrect statement? A) The male urethra serves both the urinary and reproductive systems at the same time. B) The male urethra serves both the urinary and reproductive systems but at different times. C) The male urethra is longer than the female urethra. D) The male urethra is a passageway for both urine and semen. Answer: A Diff: 1 Page Ref: 987 20) Which of the following acts as the trigger for the initiation of micturition (voiding)? A) the stretching of the bladder wall B) motor neurons C) the pressure of the fluid in the bladder D) the sympathetic efferents Answer: A Diff: 1 Page Ref: 988 21) The filtration membrane includes all except ________. A) glomerular endothelium B) podocytes C) renal fascia D) basement membrane Answer: C Diff: 2 Page Ref: 969 11 Copyright © 2010 Pearson Education, Inc. 22) The mechanism of water reabsorption by the renal tubules is ________. A) active transport B) osmosis C) solvent drag D) cotransport with sodium ions Answer: B Diff: 2 Page Ref: 975978 23) Most electrolyte reabsorption by the renal tubules is ________. A) not Tm limited B) in the distal convoluted tubule C) hormonally controlled in distal tubule segments D) completed by the time the loop of Henle is reached Answer: C Diff: 2 Page Ref: 978 24) The macula densa cells respond to ________. A) aldosterone B) antidiuretic hormone C) changes in pressure in the tubule D) changes in solute content of the filtrate Answer: D Diff: 2 Page Ref: 968969 25) Which of the following is not reabsorbed by the proximal convoluted tubule? A) Na + B) K + C) glucose D) creatinine Answer: D Diff: 2 Page Ref: 976 26) The fluid in the glomerular (Bowman's) capsule is similar to plasma except that it does not contain a significant amount of ________. A) glucose B) hormones C) electrolytes D) plasma protein Answer: D Diff: 2 Page Ref: 969, 971 12 Copyright © 2010 Pearson Education, Inc. 27) Alcohol acts as a diuretic because it ________. A) is not reabsorbed by the tubule cells B) increases the rate of glomerular filtration C) increases secretion of ADH D) inhibits the release of ADH Answer: D Diff: 2 Page Ref: 982 28) The function of angiotensin II is to ________. A) constrict arterioles and increase blood pressure B) decrease the production of aldosterone C) decrease arterial blood pressure D) decrease water absorption Answer: A Diff: 2 Page Ref: 972 29) A disease caused by inadequate secretion of antidiuretic hormone (ADH) by the pituitary gland with symptoms of polyuria is ________. A) diabetes mellitus B) diabetes insipidus C) diabetic acidosis D) coma Answer: B Diff: 2 Page Ref: 991 30) An important characteristic of urine is its specific gravity or density, which is ________. A) 1.0411.073 B) 1.0011.035 C) 1.0301.040 D) 1.0001.015 Answer: B Diff: 2 Page Ref: 985 13 Copyright © 2010 Pearson Education, Inc. 31) 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 A) 3, 1, 2, 6, 5, 4 B) 6, 3, 2, 1, 5, 4 C) 2, 1, 3, 6, 5, 4 D) 3, 6, 2, 1, 5, 4 Answer: D Diff: 2 Page Ref: 961962 32) Select the correct statement about the nephrons. A) The parietal layer of the glomerular capsule is simple squamous epithelium. B) The glomerulus is correctly described as the proximal end of the proximal convoluted tubule. C) Podocytes are the branching epithelial cells that line the tubules of the nephron. D) Filtration slits are the pores that give fenestrated capillaries their name. Answer: A Diff: 2 Page Ref: 964 33) What would happen if the capsular hydrostatic pressure were increased above normal? A) Net filtration would increase above normal. B) Net filtration would decrease. C) Filtration would increase in proportion to the increase in capsular pressure. D) Capsular osmotic pressure would compensate so that filtration would not change. Answer: B Diff: 2 Page Ref: 971972 34) Which of the following is not a part of the juxtaglomerular apparatus? A) granular cells B) macula densa C) podocyte cells D) mesangial cells Answer: C Diff: 2 Page Ref: 968969 14 Copyright © 2010 Pearson Education, Inc. 35) Tubular reabsorption ________. A) includes substances such as creatinine B) by active mechanisms usually involves movement against an electrical and/or chemical gradient C) by passive processes requires ATP to move solutes from the interior of the tubule to the blood D) is a way for the body to get rid of unwanted waste Answer: B Diff: 2 Page Ref: 974 36) Which of the following is not a reason why substances are either not reabsorbed or are incompletely reabsorbed from the nephron? A) They lack carriers. B) They are not lipid soluble. C) They are too large to pass through the fenestrations. D) They are extremely complex molecules. Answer: D Diff: 1 Page Ref: 976, 978 37) Reabsorption of high levels of glucose and amino acids in the filtrate is accomplished by ________. A) facilitated diffusion B) passive transport C) countertransport D) secondary active transport Answer: D Diff: 2 Page Ref: 975 38) Which of the choices below is a function of the loop of Henle? A) form a large volume of very concentrated urine or a small volume of very dilute urine B) form a large volume of very dilute urine or a small volume of very concentrated urine C) absorb electrolytes actively with an automatic absorption of water by osmosis D) none of these Answer: B Diff: 2 Page Ref: 976, 978 39) Fetal kidneys do not have to work very hard because ________. A) fetuses do not have any waste to excrete B) there are no functional nephrons until after birth C) the placenta allows the mother's urinary system to clear the waste from fetal blood D) there is no way a fetus could excrete urine until the seventh month of development Answer: C Diff: 2 Page Ref: 989 15 Copyright © 2010 Pearson Education, Inc. 40) Which of the following best describes kidney function in older adults (70 years or older)? A) Kidney function remains the same throughout life, regardless of age. B) Only about 3% of older adults have any loss of kidney function. C) Only obese and diabetic older adults have any kidney dysfunction. D) Kidney function decreases due to kidney atrophy. Answer: D Diff: 2 Page Ref: 991 41) The factor favoring filtrate formation at the glomerulus is the ________. A) colloid osmotic pressure of the blood B) glomerular hydrostatic pressure C) capsular hydrostatic pressure D) myogenic mechanism Answer: B Diff: 3 Page Ref: 971 42) If the Tm for a particular amino acid is 120 mg/100 ml and the concentration of that amino acid in the blood is 230 mg/100 ml, the amino acid will ________. A) be actively secreted into the filtrate B) be completely reabsorbed by the tubule cells C) appear in the urine D) be reabsorbed by secondary active transport Answer: C Diff: 3 Page Ref: 975 43) If one says that the clearance value of glucose is zero, what does this mean? A) The glucose molecule is too large to be filtered out of the blood. B) Most of the glucose is filtered out of the blood and is not reabsorbed in the convoluted tubules. C) Normally all the glucose is reabsorbed. D) The clearance value of glucose is relatively high in a healthy adult. Answer: C Diff: 3 Page Ref: 984 44) Excretion of dilute urine requires ________. A) relative permeability of the distal tubule to water B) impermeability of the collecting tubule to water C) transport of sodium and chloride ions out of the descending loop of Henle D) the presence of ADH Answer: B Diff: 3 Page Ref: 982 16 Copyright © 2010 Pearson Education, Inc. 45) Which of the choices below is not a method by which the cells of the renal tubules can raise blood pH? A) by secreting hydrogen ions into the filtrate B) by reabsorbing filtered bicarbonate ions C) by producing new bicarbonate ions D) by secreting sodium ions Answer: D Diff: 1 Page Ref: 978 46) In the ascending limb of the loop of Henle the ________. A) thin segment is freely permeable to water B) thick segment is permeable to water C) thin segment is not permeable to sodium and chloride D) thick segment moves ions out into interstitial spaces for reabsorption Answer: D Diff: 3 Page Ref: 976, 978 47) Select the correct statement about urinary system development. A) Kidneys develop from urogenital ridges. B) The metanephric ducts will become the urethras. C) The pronephros (first tubule system) develops during the tenth week of gestation. D) The mesonephros will develop into the kidneys. Answer: A Diff: 3 Page Ref: 988 48) Which of the choices below does not describe the importance of tubular secretion? A) disposing of substances not already in the filtrate, such as certain drugs B) eliminating undesirable substances such as urea and uric acid that have been reabsorbed by passive processes C) ridding the body of bicarbonate ions D) ridding the body of excessive potassium ions Answer: C Diff: 2 Page Ref: 978 49) Which statement is correct? A) Reabsorption of water is hormonally controlled. B) Normal filtrate contains a large amount of protein. C) Most of the water passing through the kidney is eliminated as urine. D) The excretion of sodium ions is one of the mechanisms that maintains the pH balance of the blood. Answer: A Diff: 3 Page Ref: 975 17 Copyright © 2010 Pearson Education, Inc. 50) What is the function of the juxtaglomerular apparatus? A) help regulate blood pressure and the rate of blood filtration by the kidneys B) help regulate blood pressure and the rate of excretion by the kidneys C) help regulate urea absorption by the kidneys D) help regulate water and electrolyte excretion by the kidneys Answer: A Diff: 2 Page Ref: 968969 51) Which of the choices below is the salt levelmonitoring part of the nephron? A) macula densa B) principal cell C) vasa recta D) loop of Henle Answer: A Diff: 2 Page Ref: 968969 52) Which of the hormones below is responsible for facultative water reabsorption? A) ADH B) thyroxine C) aldosterone D) atrial natriuretic peptide Answer: A Diff: 1 Page Ref: 975 53) Which of the choices below is not a glomerular filtration rate control method? A) renal autoregulation B) neural regulation C) electrolyte levels D) hormonal regulation Answer: C Diff: 2 Page Ref: 972 54) Which of the choices below are the most important hormone regulators of electrolyte reabsorption and secretion? A) angiotensin II and ADH B) angiotensin II and aldosterone C) angiotensin I and epinephrine D) angiotensin I and atrial natriuretic peptide Answer: B Diff: 3 Page Ref: 972974 18 Copyright © 2010 Pearson Education, Inc. 55) Which cells of the kidney are chemoreceptors that respond to changes in solute content of the filtrate? A) juxtaglomerular cells B) mesangial cells C) macula densa cells D) podocytes Answer: C Diff: 3 Page Ref: 968969 FillintheBlank/Short Answer Questions 1) The capillary bed that surrounds the descending and ascending loop of Henle of juxtamedullary nephrons is called the ________. Answer: vasa recta Diff: 1 Page Ref: 968 2) Urine crystals in the renal pelvis are called ________. Answer: renal calculi Diff: 1 Page Ref: 986 3) The need to get up in the middle of the night to urinate is called ________. Answer: nocturia Diff: 1 Page Ref: 991 4) The area between the ureters and urethra is called the ________ in a bladder. Answer: trigone Diff: 1 Page Ref: 986 5) The ________ mechanism is the general tendency of vascular smooth muscle to contract when stretched. Answer: myogenic Diff: 2 Page Ref: 972 6) The presence of pus in the urine is a condition called ________. Answer: pyuria Diff: 2 Page Ref: 985; Tbl. 25.2 7) Sodiumlinked water flow across a membrane is called ________ water reabsorption. Answer: obligatory Diff: 2 Page Ref: 975 8) Explain how filtration works in the glomerular capillaries. Answer: 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. 19 Copyright © 2010 Pearson Education, Inc. Diff: 2 Page Ref: 969, 971 9) List three substances that are abnormal urinary constituents and provide the proper clinical term for such abnormalities. Answer: 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). Diff: 3 Page Ref: 985; Tbl. 25.2 10) Explain the role of aldosterone in sodium and water balance. Answer: 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. Diff: 2 Page Ref: 978 11) Explain what is meant by the terms cotransport process and transport maximum. Answer: 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. Diff: 2 Page Ref: 975976 12) 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. Answer: Facultative water reabsorption depends on the presence of antidiuretic hormone. In the presence of ADH, the pores of the collecting tubule enlarge 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. Diff: 3 Page Ref: 981 13) List and describe three pressures operating at the filtration membrane, and explain how each influences net filtration pressure. Answer: 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. Diff: 3 Page Ref: 969, 971 14) In addition to the reninangiotensin mechanism, the renal cells produce other chemicals. Name four, and briefly give the main function of each. Answer: Renal cells also produce chemicals, some of which act locally as signaling molecules. 20 Copyright © 2010 Pearson Education, Inc. These chemicals include prostaglandins (vasodilators and vasoconstrictors), which probably regulate GFR; nitric oxide, a potent vasodilator produced by the vascular endothelium; adenosine, which constricts renal vasculature; and endothelin, a vasoconstrictor that inhibits renin release. Diff: 3 Page Ref: 972974 15) What are aquaporins? Answer: Aquaporins are waterfilled pores in waterpermeable portions of the convoluted tubules such as the PCT. Diff: 2 Page Ref: 975 16) Freshly voided urine has very little smell, but shortly after voiding it can give off a very strong smell. Why? Answer: 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. Diff: 2 Page Ref: 985 Clinical Questions 1) 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. X rays indicate a shadow on his right ureter. Diagnose his problem. Give suggested treatment and prognosis. Answer: The symptoms indicate a kidney stone that has been passed into the ureter. Treatment would be IV therapy to flush the stone out, surgery, or ultrasound waves to shatter the calculi. The prognosis is for complete recovery. There is a possibility of kidney stones forming again. Diff: 2 Page Ref: 986 2) What clinical effects would high blood pressure have on the kidneys of a bedridden patient? Answer: This patient would have a much higher glomerular hydrostatic pressure and would therefore lose more fluids than normal. Because of the threat of dehydration, the staff should make sure the patient drinks plenty of water. Diff: 3 Page Ref: 969, 971 3) Elevenyearold Harry is complaining of a severe sore throat and gets to stay home from school. His pediatrician prescribes a course of broadspectrum 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. Answer: Harry is showing the symptoms of kidney inflammation. The smoky brown color of the urine indicates the presence of blood or bile. 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. The kidney inflammation is called either pyelitis (involves only the renal pelvis and calyces) or 21 Copyright © 2010 Pearson Education, Inc. pyelonephritis (affects the whole kidney). Diff: 3 Page Ref: 988 22 Copyright © 2010 Pearson Education, Inc. 4) Ellen, a 47yearold 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? Answer: 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. Diff: 3 Page Ref: 985 5) 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? Answer: 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. Diff: 2 Page Ref: 988 6) A patient is 18 years old and 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? Answer: 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. The nurse should also explain that sexually transmitted infections can also inflame the urinary tract, clogging some of its ducts. Diff: 2 Page Ref: 988 7) A 58yearold 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. Answer: Stress incontinence is found most commonly in women with relaxed pelvic musculature deprived of estrogen. Stress incontinence may occur with a sudden increase in intraabdominal pressure such as coughing or sneezing, which forces urine through the external sphincter. Diff: 2 Page Ref: 988 8) Explain how an angiotensin converting enzyme inhibitor (ACE inhibitor) such as captopril would be effective as an antihypertensive. Answer: 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 reninangiotensinaldosterone system. Diff: 2 Page Ref: 972974 23 Copyright © 2010 Pearson Education, Inc. 24 Copyright © 2010 Pearson Education, Inc.
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