NR507 Final Exam Study Guide 2026/2027 / NR 507 Week 5 - 8
Advanced Pathophysiology Actual Exam UP-TO-DATE 2026 EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS | Question And VERIFIED
ANSWERS
SECTION 1: RENAL & URINARY SYSTEM PATHOPHYSIOLOGY
Question 1:
A patient with chronic kidney disease (CKD) has a GFR of 25 mL/min. Which stage of
CKD is this?
A) Stage 2 (Mild CKD)
B) Stage 3 (Moderate CKD)
C) Stage 4 (Severe CKD)
D) Stage 5 (End-stage CKD)
Correct Answer: C) Stage 4 (Severe CKD)
Rationale: Stage 4 CKD is defined as a GFR of 15-29 mL/min. Stage 5 is <15 mL/min
(end-stage), stage 3 is 30-59 mL/min, and stage 2 is 60-89 mL/min. This patient's GFR of
25 mL/min places them in Stage 4, indicating severe kidney dysfunction requiring
preparation for renal replacement therapy .
Question 2:
Which electrolyte imbalance is most concerning in acute kidney injury (AKI) due to
rhabdomyolysis?
A) Hyponatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hyperphosphatemia
Correct Answer: B) Hyperkalemia
,Rationale: Rhabdomyolysis causes release of potassium from damaged muscle cells,
leading to life-threatening hyperkalemia. This can cause cardiac arrhythmias and
requires immediate intervention. Hyperkalemia is the most acutely dangerous
electrolyte disturbance in this setting .
Question 3:
A patient with prerenal AKI would most likely have which finding on urinalysis?
A) Fractional excretion of sodium (FENa) >2%
B) Fractional excretion of sodium (FENa) <1%
C) Muddy brown casts
D) Dysmorphic RBCs
Correct Answer: B) Fractional excretion of sodium (FENa) <1%
Rationale: In prerenal AKI, the kidneys are functioning normally but are underperfused.
Healthy tubules respond by retaining sodium, resulting in a FENa <1%. FENa >2%
suggests intrinsic renal damage (e.g., acute tubular necrosis). Muddy brown casts are
associated with ATN, and dysmorphic RBCs indicate glomerular bleeding .
Question 4:
Poststreptococcal glomerulonephritis typically presents with which urinalysis finding?
A) White blood cell casts
B) Dysmorphic RBCs and RBC casts
C) Fatty casts
D) Broad waxy casts
Correct Answer: B) Dysmorphic RBCs and RBC casts
Rationale: Poststreptococcal glomerulonephritis is characterized by glomerular
inflammation causing bleeding into Bowman's space. This results in dysmorphic
(misshapen) red blood cells and red blood cell casts in the urine. These findings indicate
glomerular bleeding rather than lower urinary tract bleeding .
,Question 5:
A patient with benign prostatic hyperplasia (BPH) develops sudden anuria. What is the
most likely cause?
A) Prerenal AKI
B) Acute complete urinary retention
C) Nephrolithiasis
D) Pyelonephritis
Correct Answer: B) Acute complete urinary retention
Rationale: BPH can cause obstruction of the prostatic urethra, leading to acute
complete urinary retention, which presents as sudden anuria (no urine output). This is a
urologic emergency requiring catheterization. Prerenal causes would not cause
complete anuria, and stones typically cause pain with obstruction .
Question 6:
Which medication is most associated with causing acute interstitial nephritis (AIN)?
A) Penicillin
B) NSAIDs (e.g., ibuprofen)
C) Acetaminophen
D) Lisinopril
Correct Answer: B) NSAIDs (e.g., ibuprofen)
Rationale: NSAIDs, penicillins, and proton pump inhibitors are common causes of drug-
induced acute interstitial nephritis. NSAIDs are particularly associated with this
condition. AIN is characterized by inflammation of the renal interstitium, leading to AKI
with sterile pyuria, eosinophiluria, and often normal or mildly elevated proteinuria .
Question 7:
In renal tubular acidosis (RTA) type 1 (distal), what acid-base disorder is seen?
, A) High anion gap metabolic acidosis
B) Normal anion gap metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Correct Answer: B) Normal anion gap metabolic acidosis
Rationale: Distal RTA (Type 1) is characterized by impaired distal tubule acid excretion,
leading to a normal anion gap (hyperchloremic) metabolic acidosis. The kidneys fail to
excrete hydrogen ions, but the anion gap remains normal because chloride is retained
to maintain electroneutrality .
Question 8:
Polycystic kidney disease (ADPKD) is most commonly associated with which genetic
mutation?
A) PKD1 gene on chromosome 16
B) PKD2 gene on chromosome 4
C) PKHD1 gene on chromosome 6
D) COL4A5 gene on chromosome X
Correct Answer: A) PKD1 gene on chromosome 16
Rationale: Autosomal dominant polycystic kidney disease (ADPKD) is most commonly
caused by mutations in the PKD1 gene (chromosome 16), accounting for approximately
85% of cases. PKD2 mutations (chromosome 4) account for about 15% of cases. PKD1
mutations generally cause earlier onset and more severe disease .
Question 9:
What is the most common cause of end-stage renal disease (ESRD) in adults worldwide?
A) Hypertension
B) Diabetes mellitus
C) Glomerulonephritis
D) Polycystic kidney disease
Advanced Pathophysiology Actual Exam UP-TO-DATE 2026 EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS | Question And VERIFIED
ANSWERS
SECTION 1: RENAL & URINARY SYSTEM PATHOPHYSIOLOGY
Question 1:
A patient with chronic kidney disease (CKD) has a GFR of 25 mL/min. Which stage of
CKD is this?
A) Stage 2 (Mild CKD)
B) Stage 3 (Moderate CKD)
C) Stage 4 (Severe CKD)
D) Stage 5 (End-stage CKD)
Correct Answer: C) Stage 4 (Severe CKD)
Rationale: Stage 4 CKD is defined as a GFR of 15-29 mL/min. Stage 5 is <15 mL/min
(end-stage), stage 3 is 30-59 mL/min, and stage 2 is 60-89 mL/min. This patient's GFR of
25 mL/min places them in Stage 4, indicating severe kidney dysfunction requiring
preparation for renal replacement therapy .
Question 2:
Which electrolyte imbalance is most concerning in acute kidney injury (AKI) due to
rhabdomyolysis?
A) Hyponatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hyperphosphatemia
Correct Answer: B) Hyperkalemia
,Rationale: Rhabdomyolysis causes release of potassium from damaged muscle cells,
leading to life-threatening hyperkalemia. This can cause cardiac arrhythmias and
requires immediate intervention. Hyperkalemia is the most acutely dangerous
electrolyte disturbance in this setting .
Question 3:
A patient with prerenal AKI would most likely have which finding on urinalysis?
A) Fractional excretion of sodium (FENa) >2%
B) Fractional excretion of sodium (FENa) <1%
C) Muddy brown casts
D) Dysmorphic RBCs
Correct Answer: B) Fractional excretion of sodium (FENa) <1%
Rationale: In prerenal AKI, the kidneys are functioning normally but are underperfused.
Healthy tubules respond by retaining sodium, resulting in a FENa <1%. FENa >2%
suggests intrinsic renal damage (e.g., acute tubular necrosis). Muddy brown casts are
associated with ATN, and dysmorphic RBCs indicate glomerular bleeding .
Question 4:
Poststreptococcal glomerulonephritis typically presents with which urinalysis finding?
A) White blood cell casts
B) Dysmorphic RBCs and RBC casts
C) Fatty casts
D) Broad waxy casts
Correct Answer: B) Dysmorphic RBCs and RBC casts
Rationale: Poststreptococcal glomerulonephritis is characterized by glomerular
inflammation causing bleeding into Bowman's space. This results in dysmorphic
(misshapen) red blood cells and red blood cell casts in the urine. These findings indicate
glomerular bleeding rather than lower urinary tract bleeding .
,Question 5:
A patient with benign prostatic hyperplasia (BPH) develops sudden anuria. What is the
most likely cause?
A) Prerenal AKI
B) Acute complete urinary retention
C) Nephrolithiasis
D) Pyelonephritis
Correct Answer: B) Acute complete urinary retention
Rationale: BPH can cause obstruction of the prostatic urethra, leading to acute
complete urinary retention, which presents as sudden anuria (no urine output). This is a
urologic emergency requiring catheterization. Prerenal causes would not cause
complete anuria, and stones typically cause pain with obstruction .
Question 6:
Which medication is most associated with causing acute interstitial nephritis (AIN)?
A) Penicillin
B) NSAIDs (e.g., ibuprofen)
C) Acetaminophen
D) Lisinopril
Correct Answer: B) NSAIDs (e.g., ibuprofen)
Rationale: NSAIDs, penicillins, and proton pump inhibitors are common causes of drug-
induced acute interstitial nephritis. NSAIDs are particularly associated with this
condition. AIN is characterized by inflammation of the renal interstitium, leading to AKI
with sterile pyuria, eosinophiluria, and often normal or mildly elevated proteinuria .
Question 7:
In renal tubular acidosis (RTA) type 1 (distal), what acid-base disorder is seen?
, A) High anion gap metabolic acidosis
B) Normal anion gap metabolic acidosis
C) Respiratory acidosis
D) Metabolic alkalosis
Correct Answer: B) Normal anion gap metabolic acidosis
Rationale: Distal RTA (Type 1) is characterized by impaired distal tubule acid excretion,
leading to a normal anion gap (hyperchloremic) metabolic acidosis. The kidneys fail to
excrete hydrogen ions, but the anion gap remains normal because chloride is retained
to maintain electroneutrality .
Question 8:
Polycystic kidney disease (ADPKD) is most commonly associated with which genetic
mutation?
A) PKD1 gene on chromosome 16
B) PKD2 gene on chromosome 4
C) PKHD1 gene on chromosome 6
D) COL4A5 gene on chromosome X
Correct Answer: A) PKD1 gene on chromosome 16
Rationale: Autosomal dominant polycystic kidney disease (ADPKD) is most commonly
caused by mutations in the PKD1 gene (chromosome 16), accounting for approximately
85% of cases. PKD2 mutations (chromosome 4) account for about 15% of cases. PKD1
mutations generally cause earlier onset and more severe disease .
Question 9:
What is the most common cause of end-stage renal disease (ESRD) in adults worldwide?
A) Hypertension
B) Diabetes mellitus
C) Glomerulonephritis
D) Polycystic kidney disease
