Renal Disorders

Renal Disorders

Which of the following are true? Select all that apply.Renin levels increase with poor kidney perfusion.Heart failure results in postrenal failure.Nephrotoxic drugs are a cause of intrarenal failure.Staphylococcal infections are common causes of kidney failure.Spinal stenosis pain is common symptom of kidney dysfunction.

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A nurse is assessing the laboratory results of a client who is suspected of having glomerular damage. Which value of serum albumin is most indicative of the condition in this client?4.0 g/dL5.0 g/dL2.5 g/dL5.5 g/dL

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Which statements are valid only for prerenal kidney injury when compared with both intrarenal and postrenal kidney injury? Select all that apply.Can be caused by prostatic hyperplasiaIs associated with a significant increase in the glomerular filtration rate (GFR)Caused by any condition that decreases blood flow and renal perfusionCan be caused by radiopaque dye used in imaging studiesCan be caused by hypovolemic shock

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Infection of the renal system may be evident by the presence of which of the following in a urine sample? Select all that apply.NitriteLeukocyte esteraseCalciumGlucoseAlbumin

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Increasing serum creatinine levels may indicate _________________.decreased blood urea nitrogenreduced glomerular filtration rateazotemiaincreasing glomerular filtration rate

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Choose the classification for each type of renal dysfunction.Nephrotoxic medications

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Because of the diverse roles of the kidneys, kidney dysfunction may present in a number of ways. Decreased perfusion of the kidneys activates the renin-angiotensin-aldosterone system, abbreviated RAAS, increasing sodium and water retention and potentially leading to hypertension. As the kidneys produce erythropoietin to increase red blood cells, failing kidneys cause lower than normal red blood cell levels. The kidneys also synthesize vitamin D, which helps absorb calcium. Hypocalcemia may develop in kidney failure. Now let's shift to categories of kidney dysfunction, which is based on the area of injury.Prerenal dysfunction implies a problem "before" the kidneys. It occurs when blood flow and perfusion to the kidneys is reduced. Heart failure, trauma, and shock may cause prerenal failure. Intrarenal dysfunction results from an injury to the kidney itself. Nephrotoxic drugs, streptococcal infections, and systemic diseases may induce this type of damage. Postrenal dysfunction occurs "after" the kidney, and results from an obstruction that prevents outflow from the kidney.Patients at risk for renal dysfunction include those taking nephrotoxic medications, those with recent streptococcal infections, patients suffering from diabetes mellitus and/or hypertension, and patients who have had major surgery.Costovertebral angle pain is a classic sign of kidney dysfunction, as are hematuria, defined as blood in the urine, and proteinuria, defined as protein in the urine. Urine analysis can provide clues to dysfunction within the kidneys themselves or within other body systems. The specific gravity of urine is a measurement of urine concentration, and may be altered in states such as dehydration. Glucose in the urine most commonly results from hyperglycemia, and may indicate diabetes. Diabetic ketoacidosis may cause ketones to appear in the urine. Proteins in the urine can result from intense exercise, after which minimal levels may appear, and from glomerulonephritis, which may lead to more significant levels. Blood in the urine may indicate damage to structures of the renal system. The presence of bilirubin and urobilinogen may indicate liver damage, whereas the presence of nitrite and leukocyte esterase normally indicate infection of the renal system.Kidney function can also be evaluated by analyzing blood levels of blood urea nitrogen, abbreviated BUN, and creatinine, abbreviated Cr. Both are waste products that should be filtered and removed by the kidneys. Azotemia is an increase in BUN levels. Increased SERUM creatinine may indicate reduced glomerular filtration rate, abbreviated GFR. Creatinine clearance is sometimes measured to assess glomerular functioning.Kidney dysfunction may become so compromised that dialysis may be required. Two forms of dialysis may be used, peritoneal dialysis, in which a patient's peritoneum is filled with fluid to be exchanged, and hemodialysis, in which blood is drawn from the body, run through a dialyzer, and then returned to the body. Both methods seek to carry out the kidney's function of filtering the blood.

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Choose the classification for each type of renal dysfunction.Erythropoietin levels in kidney failureINCREASEDUNCHANGEDDECREASED

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Choose the classification for each type of renal dysfunction.ShockPRERENALINTRARENALPOSTRENAL

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Choose the classification for each type of renal dysfunction.AzotemiaINCREASED SERUM BUNDECREASED SERUM BUNINCREASED GFR

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Choose the classification for each type of renal dysfunction.Postrenal failureNEPHROTOXIC DRUGSBENIGN PROSTATIC HYPERPLASIADECREASED KIDNEY PERFUSION

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Choose the classification for each type of renal dysfunction.Damaging infection to kidneySTAPHYLOCOCCALCLOSTRIDIALSTREPTOCOCCAL

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Choose the classification for each type of renal dysfunction.Pain presentation with kidney pathologiesSEVERE HEADACHECOSTOVERTEBRAL ANGLE PAINRIGHT UPPER QUADRANT PAIN

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Choose the classification for each type of renal dysfunction.Type of dialysis in which blood drawn from body enters dialyzerHEMODIALYSISPERITONEAL DIALYSISPLEURAL DIALYSIS

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Choose the classification for each type of renal dysfunction.Type of kidney injury resulting from glomerulonephritisPRERENALINTRARENALPOSTRENAL

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Choose the classification for each type of renal dysfunction.Sign of urinary tract infection in urinalysisELEVATED KETONESELEVATED LEUKOCYTE ESTERASEELEVATED CR

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Choose the classification for each type of renal dysfunction.RAAS activation with kidney damageINCREASES SODIUM AND WATER RETENTIONSIGN THAT KIDNEY TRANSPLANT IS IMMINENTCAUSES HYPOTENSION

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Kidney failure may cause reduced vitamin ___________ synthesis, resulting in reduced _____________absorption.D, calciumE, calciumA, calciumD, potassium

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Which type of infection most commonly causes damage to the kidneys?NeisserialClostridialStreptococcalStaphylococcal

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Which of the following is a cause of prerenal failure?Nephrotoxic medicationsStreptococcal infectionDecreased perfusionUreter obstruction

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Which of the following are common signs of kidney dysfunction? Select all that apply.ProteinuriaDecreased serum creatinineRashHematuriaCostovertebral angle pain

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Which of the following are waste products that may elevate in the serum when the kidneys are failing? Select all that apply.Glomerular filtration rateAlbuminCreatinineLeukocyte esteraseBlood urea nitrogen

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A patient's urinalysis reveals the presence of glucose. Which of the following should be considered first?The patient is eating too many carbohydrates.Decreased glomerular filtration rate (GFR) is concentrating the urine too muchThe patient may have diabetes mellitus.The patient has kidney failure.

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A critical care patient is to receive continual renal replacement therapy (CRRT). What is an appropriate description to share with family members of the patient?The patient's blood will be purified over 24 hours.CRRT is a form of hemodialysis and is done every three days.CRRT is a form of plasmapheresis and removes antibodies from the plasma.CRRT provides IV infusions due to fluid loss.

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A renal patient presents with edema. What may be the primary cause of this edema?Urinary stone causing backupDecreased serum albumin due to renal loss.Increased gluconeogenesis by the kidneyDecreased erythropoietin synthesis

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Which of the following substances may be needed as a supplement for a patient suffering renal osteodystrophy?IronVitamin DGlucosamineVitamin E

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Which of the following bacterial infections is most worrisome to the clinician in regards to glomerular damage?StaphylococcalClostridialNeisseriaStreptococcal

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A patient is taking a nephrotoxic drug. Which type of renal dysfunction is the nurse most likely concerned about developing?PrerenalIntrarenalPostrenalJuxtarenal

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Glomerular filtration rate (GFR) is recorded as 12 ml/min. What is the correct interpretation by the nurse?Renal function has returned to normal. The patient is ready to be discharged.Renal function is not normal, as the patient is in stage 3 chronic renal failure (CRF).Renal function is above normal levels.Renal function indicates stage 5 CRF.

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A patient is to undergo renal ultrasound. Which of the following is the test most likely used to assess?Glomerular filtration rate (GFR)HydronephrosisCastsAzotemia

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A patient has oliguria. Which of the following interpretations by the nurse is correct?The patient has increased urine output compared to normal.The patient has a urinary stone.The patient's urine output is less than 400 ml/day.The patient's glomerular filtration rate (GFR) must be elevated.

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A patient passes a kidney stone. What is the most likely composition of the stone?CystineUric acidCalciumMagnesium

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A patient is suffering declining kidney function due to an autoimmune disease. The patient asks the nurse how much of his kidney must suffer damage to lead to end stage renal disease (ESRD). Which of the following is the appropriate response by the nurse?Usually ESRD develops when less than 10% of the nephrons are damaged.Usually ESRD develops when 10% to 20% of the nephrons are damaged.Usually ESRD develops when 65% to 75% of the nephrons are damaged.Usually ESRD develops when 90% to 95% of the nephrons are damaged.

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A nursing student is studying the progression of acute kidney injury. What is the proper order for the progression of acute kidney injury?Kidney function decreasesOliguria developsInitial insult or injury to the kidneyDiuresis with reduced concentrating ability by kidneyRecovery with return to normal urine concentration

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A nurse is reviewing urinalysis results. Which factors does she review to see whether the patient has a urinary tract infection? Select all that apply.GlucoseBilirubinAlbuminLeukocyte esteraseNitrite

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A nurse is evaluating a patient's risk for renal disorders. Which of the following increase the risk for renal dysfunction? Select all that apply.A patient with diabetes mellitusA patient with severe hypertensionA patient with systemic lupus erythematosusA patient with cirrhosisA patient with peptic ulcer disease

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A patient's glomerular filtration rate (GFR) is 110 ml/min. Which of the following interpretations is correct?Renal function is normal.The value is too high; the kidneys are not concentrating the urine.This value is too low; the patient is retaining fluids.The value is too low due to decreased renal perfusion.

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A patient is diagnosed with Goodpasture's syndrome. Which of the following statements are true about this condition? Select all that apply.Goodpasture's syndrome is an autoimmune disease.Goodpasture's syndrome is often asymptomatic.Goodpasture's syndrome is a form of PKD.Goodpasture's syndrome is an inherited disorder.Dialysis may be required to treat Goodpasture's syndrome.

Renal Disorders

Which of the following are true statements about acute glomerulonephritis? Select all that apply.Nephrolithiasis is a primary cause of acute glomerulonephritis.Patients with acute glomerulonephrititis have no dietary restrictions.Glomerular permeability is lessened, preventing filtration of the blood.In acute glomerulonephritis, blood cells and protein may appear in the urine.Streptococcal infections can result in glomerulonephritis.

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A student nurse compares the symptoms of acute glomerulonephritis (AGN) with nephrolithiasis. Which symptoms should the student nurse identify as likely to be observed in a patient with AGN rather than nephrolithiasis? Select all that apply.Patient writhing in painCola-colored urineUreteral colic painCostovertebral angle tendernessSudden edema and hematuria

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Chronic renal failure (CRF)_________.appears with normal CBC and serum electrolyte levels.has a rapid and progressive onset.is always the result of prerenal kidney injury.follows five stages of progression with decreasing glomerular filtration rate.

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Chronic renal failure may be associated with which of the following conditions? Select all that apply.HypertensionDiabetesOsteoporosisStaphylococcal infectionsInfluenza infection

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The renal system works as the body's wastewater treatment facility. It filters the bloodstream of waste products and excretes urine, all while helping to control blood pressure, regulate red blood cell production, break down drugs, metabolize hormones, and balance the bloodstream's pH. When this system breaks down, a wide range of disorders can occur.Let's start by looking at acute glomerulonephritis, which most commonly arises from a streptococcal infection that begins as a sore throat and later causes an immunological reaction in the glomeruli. Antibodies damage the glomeruli and disrupt the filtration barrier of the kidneys. This causes hyperpermeability of capillaries, which allows loss of albumin and red blood cells to the urine. The patient can develop edema, most commonly around the peri-orbital region.Goodpasture's syndrome is an acute, rapidly progressive type of glomerulonephritis, in which autoantibodies attack the glomerular membrane and, possibly, lung alveoli. As the glomeruli are destroyed, proteins and red blood cell casts appear in the urine. Plasmapheresis is a process by which the glomeruili-damaging antibodies are removed from the body.Nephrotic syndrome is a disorder that results in damage to the glomeruli due to diseases such as diabetes mellitus, amyloidosis, and systemic lupus erythematosus. As the glomeruli are damaged, the filtration barrier is compromised and proteins and cells appear in the urine, while serum levels of blood urea nitrogen and creatinine elevate.Nephrolithiasis, defined as stone or calculi formation within the kidneys, develops due to the following metabolic risk factors: hypercalcemia, hyperoxaluria, hyperuricemia, hyperparathyroidism, and gout. Dietary factors, intestinal absorption issues, and endocrine abnormalities contribute to these states. Pain is the major symptom of nephrolithiasis, and excruciating flank pain is often reported. Treatments include waiting for the stone to pass and lithotripsy.Pyelonephritis is an infection of the renal pelvis; it is often preceded by a blockage or obstruction, as stagnant urine encourages bacterial growth. Patients may report chills, flank pan, increased urinary frequency, and dysuria. As pyelonephritis is caused by infection, determining the infectious agent is key. Urinalysis will reveal elevated nitrites, indicating presence of bacteria, and elevated leukocyte esterase. There will be no gross hematuria.Polycystic kidney disease is a genetic disorder that causes fluid-filled cysts to form in the kidneys. The fluid-filled cysts compress kidney structures, causing pain. If blood vessels become compressed, the renin-angiotensin-aldosterone system may activate, leading to hypertension. In addition, fluid in the cysts can precipitate and form stones. Treatment is primarily supportive and designed to limit cyst formation. Now, let's look at the acute and chronic forms of kidney dysfunction.Acute kidney injury is a sudden decline in glomerular filtration that is usually reversible. It occurs in three forms: prerenal, intrarenal, and postrenal, with prerenal being the most common. Patient presentation and management will depend on which of these diverse forms is present. Unlike acute injury, chronic renal failure is progressive and irreversible. It is commonly caused by diabetes mellitus and hypertension and usually develops into end-stage renal disease, with widespread complications.

Renal Disorders

George, age 72, recently suffered a heart attack, damaging his left ventricle. He appears to be suffering from left-sided heart failure. Stroke volume, blood pressure, and cardiac output are all reduced.George's renal function may be impaired. Serum blood urea nitrogen (BUN) and creatinine (Cr) levels are increasing and glomerular filtration rate (GFR) is significantly reduced. Oliguria is present, as is edema of the face and extremities.George seems to be becoming more confused and disoriented. Further blood laboratory values reveal hypocalcemia, hyperkalemia, and anemia.Based on the information provided, which type of renal dysfunction is most likely in George's case: prerenal, intrarenal, or postrenal?PrerenalIntrarenalPostrenalNone. Based on available data, George's renal function appears normal.

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In George's condition, why is GFR lower than normal?Decreased perfusion of the kidneyElevated pressure due to hydronephrosisBlockage of the glomerular membrane by antibodiesCyst formation within the kidneys

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Why are BUN and Cr levels higher than normal in George?Disruption of the buffering systemMuscle breakdown is increasing serum levels of these factorsDecreased GFRAntibody attack of the glomeruli have increased secretion of these substances

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Why is oliguria occurring in George?Nephron cell necrosisDecreased renal perfusion and GFRIncreased BUN and Cr are blocking renal filtrationCyst formation due to genetic disease is blocking renal blood flow

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Which of the following may explain George's anemia? Select all that apply.Decreased erythropoietinNot enough protein intakeAnemia commonly accompanies heart failureLack of intrinsic factorGlomerular damage

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What type of edema is George likely to experience with renal failure?Pulmonary edemaPeriorbital edemaDependent edemaLocalized edema in feet

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Why does George experience disorientation as a result of renal failure?Elevated toxin levels in the bloodAnemiaHyperkalemiaElevated urine output by the kidney

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What treatment option should be considered first for George's condition?Peritoneal dialysisAntibioticsHemodialysisAdequate fluid maintenance

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What is the most common cause of acute glomerulonephritis?Streptococcal infectionEpstein-Barr virusStaphylococcal infectionCytomegalovirus

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Which of the following conditions result from autoantibodies attacking the glomeruli?Polycystic kidney diseasePyelonephritisNephrolithiasisGoodpasture's syndrome

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Damage to the glomeruli may result in which of the following? Select all that apply.Increased serum blood urea nitrogenIncreased serum creatinineProteinuriaHematuriaAlbuminuria

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Stone formation within the kidneys in known as _____________________.pyelonephritispolycystic kidney diseasenephrolithiasisnephrotic syndrome

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What is the cause of polycystic kidney disease?Genetic disorderAutoantibody attack of the glomeruliPrecipitation of crystals in filtrateElevated blood sugar

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The urinalysis results of a patient in the end stage of chronic renal failure is likely to show which of the following?Presence of white blood cells (WBCs), red blood cells (RBCs), and proteinElevated leukocyte esteraseElevated ketonesElevated nitrite

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A patient is diagnosed with nephrotic syndrome. Which of the following does the nurse expect to observe?Decreased serum blood urea nitrogen (BUN)Fatty casts in urineAbsence of edemaPatient in severe pain due to stone formation

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A patient arrives in the emergency department complaining of a kidney stone. Which of the following is the appropriate nursing intervention?Restrict all fluids.Withhold pain medications until the stone is passed.Strain urine.Offer sedative.

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A nursing student suspects that a patient has a lower urinary tract infection (UTI). The nursing educator, however, believes that the patient may have pyelonephritis. Which of the following signs or symptoms did the nursing educator notice that may indicate pyelonephritis?Presence of leukocyte esterase in the urinalysis resultsLevel of pain the patient is self-reportingPresence of feverPatient's past medical history

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For a confirmative diagnosis of Goodpasture's disease, the nurse anticipates which of the following?Glomerular filtration rate (GFR) measurement decreases.Positive immunoglobulin results.Intravenous pyelogram (IVP) shows obstruction.Urinalysis shows the presence of casts.

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Which of the following findings may encourage a clinician to begin considering discussing the possibility of a need for a kidney transplant?Damage to 50% of the nephronsPresence of periorbital edemaGlomerular filtration rate (GFR) < 12 ml/minProtein in urine

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A patient has polycystic kidney disease. The nurse correctly determines which of the following is the cause?Bacterial infectionAutoimmune disorderGenetic disorderToo much calcium in the diet

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A nurse is speaking to a patient with nephrotic syndrome. Which recommendations will be helpful for the patient?Ingest a high protein diet (3 to 4 g/kg/day)Ingest a low-sodium diet (< 1500 g/day)Encourage overhydrationIngest a low-calorie/restrictive diet

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Plasmapheresis would be a treatment option for a patient with which of the following conditions?Acute kidney injuryEnd-stage renal diseasePyelonephritisGoodpasture's syndrome

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A patient wants to know how he can prevent future kidney stones. Which of the following is an appropriate recommendation?Drink at least 3/L per day.Take calcium supplements.Maintain current dietary choices.Take a daily prophylactic antibiotic.

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A patient's chart shows blood urea nitrogen (BUN) is 22 mg/dL and creatinine is 2.0 mg/dL. The nurse is asked to report the BUN-to-creatinine level. What is the correct response for the nurse to make, expressed as a ratio? Enter numeral online.

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For which of the following would antibiotics be appropriate as the primary treatment? Select all that apply.Group A beta-hemolytic streptococci (GABHS) glomerulonephritisNephrotic syndromePyelonephritisGoodpasture's syndromePolycystic kidney disease

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A patient with chronic renal failure reports that he is feeling like his skin is "itching." What is an appropriate response by the nurse?Suggest that the patient switch to a different cream or lotion.Suggest that the patient switch laundry detergents.Evaluate laboratory values to assess toxin levels in the blood.Suggest the patient may be developing a sensitivity to the bed linen.

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Which of the following would alert the clinician that the patient may have acute glomerulonephritis? Select all that apply.Pain with urinationProtein in urineOliguriaBlood in urineFluid accumulation in renal pelvis

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A nurse is treating a patient with kidney dysfunction. She notices that serum albumin levels are 2.8 g/dl. Which of the following is the appropriate interpretation by the nurse?Albumin levels are normal.Albumin levels are increased. Glomerular filtration rate (GFR) must be reduced.Albumin levels are decreased, due to loss in urine.Albumin levels are unaffected by renal function; thus, this value is not helpful.