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Urinary System

1. Mr. Langlois, 71, arrives after vomiting and diarrhea for 48 hours. He reports dizziness and poor oral intake. The LPN notes dry mucous membranes, hypotension at 86/50 mmHg, and decreased urine output. His urine is dark and concentrated. He says he “hasn’t peed much today.” Which clinical manifestation indicates pre-renal AKI? *
2. Ms. Varga, 33, presents with fever, chills, and flank pain radiating to her groin. She reports burning on urination and foul-smelling urine. The LPN notes costovertebral angle tenderness on the right side and temperature of 38.9°C. Which manifestation is most associated with pyelonephritis? *
3. A 9-year-old boy is brought in by his parents after they noticed swelling around his eyes and ankles. The LPN observes periorbital edema, pitting edema in the legs, and frothy urine. The physician suspects nephrotic syndrome. Which clinical finding supports this condition? *
4. Mr. Roy, 62, with Stage 4 CKD, reports fatigue, nausea, pruritus, and a metallic taste in his mouth. His blood pressure is 168/94 mmHg, and he has bilateral ankle swelling. He states he has difficulty concentrating and sometimes feels confused. Which finding reflects worsening CKD? *
5. Mrs. Jutras, 50, arrives with sudden severe flank pain radiating to her groin. She is restless, pacing, and unable to find a comfortable position. Urinalysis shows microscopic hematuria. She says the pain comes in “waves.” What clinical manifestation supports renal calculi? *
6. A 13-year-old boy presents with facial puffiness, dark “tea-colored” urine, and recent strep throat infection. The LPN notes hypertension and mild abdominal discomfort. The mother reports his urine output has decreased. Which manifestation aligns with glomerulonephritis? *
7. Mr. Belrose, 76, reports difficulty starting his stream, dribbling, and a feeling of incomplete emptying. The LPN palpates a firm, distended bladder above the symphysis pubis. He states he urinates often but “never enough.” Which finding indicates urinary retention? *
8. Ms. Emsley, 44, with family history of PKD, reports flank discomfort, early satiety, and intermittent hematuria. The LPN notes abdominal distention suggesting enlarged kidneys. Her blood pressure today is 178/112 mmHg. Which manifestation is typical of PKD? *
9. A dialysis patient, Mr. Mukherjee, arrives for treatment with shortness of breath, crackles in both lungs, and pitting edema. He admits he missed his last dialysis due to transportation issues. His weight is 3.2 kg above baseline. Which manifestation indicates fluid overload before dialysis? *
10. Mrs. Parisi, 68, with end-stage renal disease, becomes increasingly confused, irritable, and has difficulty staying awake. Her family reports she has been missing dialysis sessions. The LPN notes ammonia-like breath odor (uremic fetor) and asterixis. Which manifestation indicates uremic encephalopathy? *
11. Mei Chen, 35, with a history of recurrent UTIs, presents with fever 39.6°C, flank pain, chills, nausea, and CVA tenderness. Despite IV antibiotics, she becomes hypotensive (BP 84/52), tachycardic, and confused with decreased urine output. What complication is likely occurring? *
12. Sarah Joseph, 29, is hospitalized for severe edema, frothy urine, and albumin 18 g/L. She complains of sudden shortness of breath and right-sided chest pain. VS: HR 132/min, RR 28/min, SpO₂ 88%. Her sudden symptoms most likely indicate: *
13. Patrick O’Donnell, 46, arrives with severe left flank pain radiating to the groin, nausea, and hematuria. CT shows a 7 mm ureteral stone. Several hours later, he develops decreased urine output and worsening flank pressure. What complication is most likely? *
14. Domenic Ricci, 54, undergoes his first hemodialysis session. Midway, he becomes nauseated, restless, with headache and blurred vision. After dialysis he becomes confused and vomits. Which complication is this most consistent with? *
15. Robert Hainsworth, 68, with BPH, reports difficulty initiating urination, weak stream, and dribbling. Tonight he has severe suprapubic pain and cannot void at all. Bladder scan shows 900 mL urine. What complication has developed? *
16. Angela Ferreira, 61, on CAPD, reports abdominal pain, fever 38.7°C, cloudy effluent, and nausea. Her abdomen is tender with rebound pain. She feels progressively weaker. What complication is most likely? *
17. Mrs. Aline Fortier, a 68-year-old woman living in a seniors’ apartment complex, is brought to the CLSC by her daughter. Over the last three days, Mrs. Fortier has been getting up frequently at night to urinate and reports a burning sensation “every time I go.” She denies flank pain but says she feels “pressure” in the lower abdomen.

Her daughter mentions that Mrs. Fortier has been more tired than usual and seemed slightly confused this morning, repeating questions. Mrs. Fortier has no history of kidney disease but has had two UTIs in the past year. She has mild stress incontinence and sometimes delays urination because “it’s too much trouble to go back and forth.”

During assessment, the nurse notes:
Temperature: 37.9°C
BP: 132/76
HR: 94
RR: 18
Lower abdominal tenderness on palpation
No CVA tenderness

While Mrs. Fortier uses the washroom to provide a urine sample, the nurse observes that the urine in the specimen cup appears opaque, with a distinctly unpleasant odor. Which clinical finding MOST strongly supports the nurse’s suspicion of a urinary tract infection? *
18. A 66-year-old patient is admitted to a medicine care unit for prostatic hypertrophy. He tells the LPN that he is always thirsty and has little energy. He has difficulty keeping his diabetes under control and admits to not following the diet suggested by his nutritionist, which has left to blurred vision over time. In addition, the patient tells the LPN that although he often goes to the bathroom to urinate, he passes only a small amount of urine, painlessly and the stream is weak. Which of the following clinical manifestations relates to the patient’s condition? *
19. A paraplegic client is waiting for a right kidney ablation after being diagnosed with kidney cancer. The LPN from the CLSC visits the client every week to monitor his vital signs. The client mentions that although his urine is becoming increasingly red during bladder catheterization, he does not feel any pain related to his condition. He uses a wheelchair to get around and remains autonomous in self-care. During the visit, the LPN observes swelling in the client’s right side. Which of the following clinical manifestations relates to the patient’s condition? *