Acute Kidney Injury: Identification and Management, Exams of Nursing

Download Acute Kidney Injury: Identification and Management and more Exams Nursing in PDF only on Docsity! 1 lOMoAR cPSD|37463924 RENAL EVOLVE Question and Answers 2024 A 48-year-old man is admitted with an acute myocardial infarction. Assessment reveals the following: Vital Signs Blood pressure 70/40 mm Hg Heart rate 122 beats/min and irregular Respiratory rate 26 breaths/min Urine output 20 mL over the past 2 hours Hemodynamics Pulmonary artery pressure (PAP) Pulmonary artery occlusive pressure (PAOP) 34/24 mm Hg 25 mm Hg 2 Right atrial pressure (RAP) 10 mm Hg Cardiac index (CI) 1.8 L/min/m2 Which of the following would be of primary concern in evaluating the patient's renal status? a. PAP b. PAOP c. RAP d. CI Correct answer: d Rationale: Of primary concern is the CI, which evaluates the cardiac output in regard to the body surface area. The kidneys receive 20% to 25% of the cardiac output, which is approximately 1200 mL/min. Without sufficient cardiac output, the kidneys cannot be perfused properly, and filtration cannot be effective. Test-Taking Strategy: If you immediately thought of mean arterial pressure but could not find it, remember that MAP = CO × SVR, where CO is cardiac output and SVR is systemic vascular resistance. Cardiac output is the pump behind glomerular filtration rate. Choose option d. <System> Renal <Section> Renal Physiology <Level> Application/Analysis 2. A 48-year-old man is admitted with an acute myocardial infarction. Assessment reveals the following: Vital Signs Blood pressure 70/40 mm Hg Heart rate 122 beats/min and irregular Respiratory rate 26 breaths/min Urine output 20 mL over the past 2 hours Hemodynamics Pulmonary artery pressure 34/24 mm Hg Pulmonary artery occlusive pressure 25 mm Hg Right atrial pressure 10 mm Hg Cardiac index 1.8 L/min/m2 What would be the best laboratory test to evaluate this patient’s glomerular filtration rate (GFR)? a. Blood urea nitrogen b. Serum creatinine c. Urine creatinine clearance d. Serum amylase Correct answer: c Rationale: Normal GFR is 125 mL/min or about 180 L/day. The creatinine clearance rate reflects the GFR. It evaluates the ability of the kidneys to filter a waste product (creatinine) that is neither reabsorbed nor secreted. Test-Taking Strategy: Notice that options a, b, and d are serum values, but option c is a comparison between the creatinine in the blood and the creatinine excreted in the urine. It is logical to believe that the comparison value would be better. 5 <Level> Synthesis/Evaluation 7. The psychiatric unit nurse telephones the critical care unit nurses with a report of a 27- year-old man with a diagnosis of "coma, undetermined cause." It is reported that he has consumed approximately 10 L of water over the past 24 hours. On admission, he is difficult to arouse, moaning occasionally, but moving all extremities purposefully and equally. Lab data reveal the following: Na 110 mEq/L Cl 80 mEq/L K 3.5 mEq/L HCO3 20 mEq/L Blood urea nitrogen 20 mg/dL Creatinine 2 mg/dL Hematocrit 22% What would be the most appropriate treatment for this patient? a. Administer hypertonic (3%) saline. b. Restrict fluids. c. Administer diuretics. d. Institute hemodialysis. Correct answer: a Rationale: Although fluid restriction and diuretics will be needed to restore normal fluid and sodium balance, the neurologic symptoms and the sodium level (less than 120 mEq/L) are indications that hypertonic saline should be used. Renal function is normal and therefore can be relied on to eliminate the water if given time, so hemodialysis is not indicated. Test-Taking Strategy: This sodium level is critical. Choose an option that will increase the sodium level quickly. Restricting fluids would be the slowest. Diuretics would be somewhat quicker. Administration of hypertonic saline would be the quickest, most direct way to elevate the sodium in this critical situation. Choose option a. Hemodialysis or continuous arteriovenous hemofiltration might be used if the patient did not have adequate renal function to achieve elimination of the extra fluid. <System> Renal <Section> Electrolytes <Level> Synthesis/Evaluation 8. The action of furosemide (Lasix) is to do which of the following? a. Act as an osmotic agent, pulling fluid into the renal tubule b. Act at the ascending limb of the loop of Henle to decrease sodium and water reabsorption c. Act as an antidiuretic hormone (ADH) antagonist d. Act as an aldosterone antagonist Correct answer: b Rationale: Loop diuretics are the most potent diuretics available. They work by blocking the reabsorption of sodium chloride at the thick segment of the medullary ascending loop of Henle. This results in a large diuresis of isotonic urine. Option a describes osmotic diuretics (e.g., mannitol). Option d describes aldosterone antagonists (e.g., spironolactone [Aldactone]). Option d ADH antagonists are not used as diuretics, but they may be used to treat syndrome of inappropriate antidiuretic hormone. Test-Taking Strategy: Because you know that furosemide is a loop diuretic, look for the 6 answer with loop in it. Choose option b. <System> Renal <Section> Pharmacology <Level> Knowledge/Comprehension 9. After an intravenous pyelogram (IVP), which of the following is an important nursing intervention? a. Ensure adequate fluid intake. b. Maintain fluid restriction. c. Provide extra doses of sodium. d. Administer antibiotics. Correct answer: a Rationale: Dehydration increases the risk of contrast-induced nephropathy, which is a rare but serious complication of IVP. Test-Taking Strategy: Remember that IVP dye is potentially nephrotoxic. Consider that when nephrotoxic agents go through the renal tubule in a concentrated form, they are more likely to cause damage to the renal tubes (acute tubular necrosis). Diluting dye by increasing fluid intake makes it less toxic. These dyes also cause osmotic diuresis, and fluids need to be replaced. Choose option a. <System> Renal <Section> Renal Assessment <Level> Knowledge/Comprehension 10. A 24-year-old man has been diagnosed with acute kidney injury as a result of severe hemorrhaging after a motor vehicle collision. How would his acute kidney injury be categorized? a. Prerenal b. Intrarenal c. Postrenal d. Tubular Correct answer: a Rationale: Prerenal failure is the result of inadequate perfusion of a normal kidney. In this situation, the severe hemorrhaging led to hypovolemia, which resulted in hypoperfusion. Test-Taking Strategy: Pre- means before and relates to perfusion of the kidney. Intrarenal or intrinsic relates to problems within, changes to, and injury of the nephron. Post- means after and relates to obstructive processes. Hemorrhage would be pre- because it is related to perfusion of the kidney. Choose option a. <System> Renal <Section> Acute Kidney Injury <Level> Knowledge/Comprehension 11. 24-year-old man has been diagnosed with acute kidney injury as a result of severe hemorrhaging after a motor vehicle collision. Which of the following would be expected laboratory values for this patient? a. Low urinary osmolality, high urinary sodium concentration b. High urinary osmolality, high urinary sodium concentration c. Low urinary osmolality, low urinary sodium concentration d. High urinary osmolality, low urinary sodium concentration 7 Correct answer: d Rationale: A high urinary osmolality (usually greater than 900 mOsm/kg) and a low urinary sodium concentration (usually less than 20 mEq/L) are normal physiologic responses to hypoperfusion in patients with normal kidneys. Test-Taking Strategy: Consider that the kidney would want to conserve sodium and water with blood loss. If the kidney is holding onto sodium, little is excreted into the urine, so urinary sodium is low. If the kidney is holding onto water, little is excreted into the urine, so it is concentrated and osmolality is increased. Choose option d. <System> Renal <Section> Acute Kidney Injury <Level> Application/Analysis 12. patient with acute kidney injury has the following arterial blood gas results: pH 7.32 PaCO2 35 mm Hg HCO3 18 mEq/L This acid/base imbalance is the result of the inability of the kidney to: a. excrete acid by-products of metabolism. b. excrete carbon dioxide. c. excrete bicarbonate ions. d. excrete calcium ions. . Correct answer: a Rationale: The patient has a metabolic acidosis because the kidneys are unable to excrete the acid by-products of cellular metabolism. Test-Taking Strategy: Because the pH is acidotic, look for an option that would cause acidosis. Inability to excrete bicarbonate ions would cause an alkalotic process, so eliminate option c. Calcium imbalances are caused by acid-base imbalances (e.g., ionized calcium decreases in alkalosis) but will not cause imbalance, so eliminate option d. Inability to excrete carbon dioxide (as carbonic acid) is the responsibility of the lungs, not the kidneys, so eliminate option b. The kidney is responsible for eliminating the acid by-products of metabolism. Choose option a. <System> Renal <Section> Acute Kidney Injury <Level> Synthesis/Evaluation Peritoneal dialysis has been initiated on a patient with acute kidney injury. On the second exchange, the nurse notices that the dialysate outflow is amber colored. Which of the following should be suspected? a. Infection in the peritoneal cavity b. Bleeding in the peritoneal cavity c. Bladder perforation d. Bowel perforation Correct answer: c Rationale: Normal dialysate outflow is clear or pale yellow. If the outflow has an amber color, the bladder could have been perforated accidentally during catheter insertion. Test-Taking Strategy: Infection causes the dialysate return to be cloudy, so eliminate option 10 b. 600 mL c. 1100 mL d. 1500 mL Correct answer: c Rationale: Fluid allowances for the patient with ARF are usually 500 mL for insensible loss added to the previous day's urine output. Test-Taking Strategy: Because you do not want the patient to become dehydrated, you know you need to give at least as much as the patient lost. Eliminate option a. Now consider that there are losses that cannot be measured, and even if you cannot remember the amount that should be allotted for insensible losses, you can eliminate option b, which allows for no insensible losses. Of the two options that are left, calculate that the insensible losses account for 500 or 900 mL per day. Almost a liter probably sounds a bit high. Choose 500 mL of insensible loss along with 600 mL of measured losses for a total of 1100 mL. Choose option c. <System> Renal <Section> Acute Kidney Injury <Level> Application/Analysis 18. 32-year-old woman has systemic lupus erythematosus and chronic kidney disease. Over the past 2 weeks, she has complained of feeling fatigued and short of breath after minimal exertion. She is receiving hemodialysis. Her hemoglobin level is 4.5 g/dL. Which of the following is indicated? a. Recombinant human erythropoietin (Epogen) b. Two units of packed red blood cells c. Nitroglycerin sublingual as needed d. Azathioprine (Imuran) Correct answer: a Rationale: This patient is having symptoms of decreased tissue oxygenation. In acute situations, this would be an indication for blood. In this patient, recombinant human erythropoietin (Epogen) is a more appropriate treatment. Epogen is used to treat anemia resulting from reduced renal production of erythropoietin (the hormone that promotes the production of red blood cells). Test-Taking Strategy: Connect the treatment with the cause. The cause of the symptoms is the decreased amount of hemoglobin to carry oxygen. The treatment is to increase the amount of hemoglobin by treating the cause. The cause of anemia in a patient with chronic renal failure is decreased renal production of erythropoietin. Choose option a. <System> Renal <Section> Chronic Kidney Disease <Level> Synthesis/Evaluation 19. A patient with acute kidney injury is undergoing her third hemodialysis treatment in 3 days. Which of the following is the best parameter to evaluate the effectiveness of fluid removal during hemodialysis? a. Blood pressure b. Blood urea nitrogen (BUN) and creatinine levels c. Postdialysis weight d. Serum potassium level 11 Correct answer: c Rationale: Weighing the patient is the most effective means of determining overall volume status. One pound is equal to 500 mL. Test-Taking Strategy: Because the question says fluid, eliminate potassium, option d. BUN is affected by fluid status, but creatinine is not, so eliminate option b. Blood pressure is affected by sympathetic tone, hormones, and other local factors along with fluid status, so eliminate option a. Choose weight as the most specific indicator of fluid removal. Choose option c. <System> Renal <Section> Fluid Balance; Acute Kidney Injury which of the following is a cause of acute tubular necrosis (ATN)? a. Nephrotoxic drugs b. Bladder carcinoma c. Glomerulonephritis d. Hypovolemia Correct answer: a Rationale: Acute tubular necrosis refers to death of renal tubule tissue. ATN is the result of ischemia that is caused by a prolonged period of hypoperfusion or nephrotoxic injury, specifically drugs or toxins. Test-Taking Strategy: Think of ATN as necrosis of the tubules caused by ischemia or nephrotoxins. Choose option a. <System> Renal <Section> Acute Kidney Injury <Level> Knowledge/Comprehension A 54-year-old man had surgery 3 days ago for repair of an abdominal aortic aneurysm. Acute kidney injury has developed. Lab values reveal the following: Na 140 mEq/L K 4.5 mEq/L Cl 100 mEq/L HCO3 24 mEq/L The anion gap would be: a. 5 mEq/L. b. 10 mEq/L. c. 15 mEq/L. d. 20 mEq/L. Correct answer: d Rationale: The anion gap = (Na + K) − (Cl + HCO3). A normal anion gap is less than 15 mEq/L. An anion gap of greater than 15 mEq/L indicates that there are unmeasured acids (e.g., lactic acidosis, ketoacidosis, certain toxins, and accumulation of fixed acids resulting from renal failure). Test-Taking Strategy: An anion gap means that there are fewer anions than there should be. So add up the main cations and subtract the main anions. Choose option d. If you cannot remember the formula but you know that increased acids increase the anion gap and you know the normal value, option d is the only abnormal value. 12 <System> Renal <Section> Electrolytes <Level> Knowledge/Comprehension A 23-year-old woman is beginning her second hemodialysis treatment for acute kidney injury. Suddenly she complains of headache and nausea. She is agitated and confused, and you notice twitching in her right hand. Which of the following is causing these findings? a. Uremia b. Dialysis disequilibrium syndrome c. Intracerebral hemorrhage d. Fluid overload Correct answer: b Rationale: Dialysis disequilibrium syndrome occurs when urea is removed from the blood at a rate faster than it is removed from the brain tissue. The greater amount of urea in the brain causes a fluid shift resulting in cerebral edema. Test-Taking Strategy: None <System> Renal <Section> Renal Replacement Therapies <Level> Application/Analysis 20. A 23-year-old woman is beginning her second hemodialysis treatment for acute kidney injury. Suddenly she complains of headache and nausea. She is agitated and confused, and you notice twitching in her right hand. Dialysis disequilibrium syndrome is diagnosed. What is the most effective prevention for dialysis disequilibrium syndrome? a. Using a lidocaine drip b. Using more heparin in the line c. Increasing the blood flow rate d. Slowing the blood flow rate Correct answer: d Rationale: You can prevent the syndrome by slowing the blood flow rate to a speed about 100 mL/min, which will help slow the rate at which the solute is removed from the vascular space. Test-Taking Strategy: Eliminate the “increasing” and “more” options (c and b) because the adverse effects probably result from something that has occurred too rapidly. <System> Renal <Section> Renal Replacement Therapies <Level> Application/Analysis 21. patient is admitted to the critical care unit 1 year after renal transplant. The patient’s serum sodium is 160 mEq/L. Which of the following would be the most likely cause of this patient’s elevated sodium level? a. Excessive oral ingestion of sodium b. Heart failure c. Rejection of the kidney d. Corticosteroid therapy Correct answer: d Rationale: Rejection would cause the blood urea nitrogen and creatinine to go up, but the sodium would be normal or decreased because of water retention. Heart failure would 15 26. A patient has urine specific gravity of 1.035, urinary sodium of 5 mEq/L, blood urea nitrogen (BUN) of 40 mg/dL, and creatinine of 1.2 mg/dL. Urinalysis reveals no proteinuria. These findings indicate which type of acute kidney injury? a. Prerenal b. Intrarenal—cortical c. Intrarenal—medullary d. Postrenal Correct answer: a Rationale: These findings indicate that the body is holding onto sodium and water. The BUN/creatinine ratio of greater than 10:1 is seen in dehydration (prerenal) or catabolism. Test-Taking Strategy: The increase in urine specific gravity is indicative of dehydration, and dehydration is the most significant cause of prerenal acute kidney injury. <System> Renal <Section> Acute Kidney Injury <Level> Application/Analysis 27. A patient develops carpopedal spasm and neuromuscular irritability manifested by Chvostek’s and Trousseau’s signs. Which electrolyte imbalance should you suspect? a. Hyperkalemia b. Hypercalcemia c. Hypermagnesemia d. Hyperphosphatemia Correct answer: d Rationale: The patient’s signs/symptoms are associated with hypocalcemia and its reciprocal condition, hyperphosphatemia. The same signs/symptoms also are seen in hypomagnesemia. Test-Taking Strategy: You probably immediately looked for hypocalcemia but could not find it among the options. To answer this question correctly, you need to remember the reciprocal relationship between calcium and phosphorus. <System> Renal <Section> Electrolytes <Level> Synthesis/Evaluation The electrolyte imbalance that is a frequent cause of postoperative paralytic ileus is which of the following? a. Hypocalcemia b. Hypokalemia c. Hypomagnesemia d. Hyponatremia e. Correct answer: b Rationale: Hypokalemia decreases gastric motility and often occurs after surgery, primarily because of the action of aldosterone. Nasogastric suctioning, vomiting, and diuresis also may contribute to perioperative potassium loss. Test-Taking Strategy: If you just identified hypokalemia as a common postoperative electrolyte imbalance, you would correctly choose option b. <System> Renal <Section> Electrolytes <Level> Application/Analysis 28. Magnesium sulfate is being given for refractory ventricular tachycardia in a patient 16 with an acute myocardial infarction. The patient becomes hypotensive with respiratory depression and hyporeflexia. What should be done? a. Call a code. b. Give calcium chloride intravenously. c. Administer furosemide (Lasix). d. Prepare for dialysis of the patient. Correct answer: b Rationale: Diuretics will increase excretion of magnesium, but they will not be fast enough to avert respiratory arrest. Dialysis is the treatment in a patient with renal failure, but if the patient does not already have a vascular access, initiating dialysis will take too long. The patient has not arrested yet, so attempt to prevent it with the administration of calcium. Calcium is an antagonist to hypermagnesemia. Test-Taking Strategy: None <System> Renal <Section> Electrolytes <Level> Synthesis/Evaluation 29. Which of the following would not be restricted during the oliguric phase of acute kidney injury? a. Protein b. Sodium c. Potassium d. Carbohydrates Correct answer: d Rationale: There are two issues here. First, restrict what the kidney will have difficulty eliminating (i.e., sodium, water, potassium, magnesium, phosphorus). Second, reduce nitrogenous wastes. While protein restriction seems obvious because protein metabolism will increase BUN, the carbohydrate issue is less obvious. Inadequate carbohydrate intake will cause catabolism (i.e., protein metabolism). Test-Taking Strategy: None <System> Renal <Section> Acute Kidney injury <Level> Synthesis/Evaluation of Elsevier, Inc. All rights reserved. 30. Which of the following would not be a risk factor for developing acute kidney injury after cardiac surgery? a. Cardiogenic shock b. Duration of cardiopulmonary bypass c. Antibiotic therapy d. Dobutamine therapy Correct answer: d Rationale: Any cause of hypoperfusion, such as cardiogenic shock or the duration of cardiopulmonary bypass, is a risk factor for acute kidney injury. Antibiotic therapy, especially aminoglycosides, is also a risk factor for kidney injury. Dobutamine would actually increase renal perfusion, and current studies indicate that dobutamine increases renal perfusion more than low-dose dopamine. Low-dose dopamine is no longer indicated to improve renal perfusion. 17 Test-Taking Strategy: None <System> Renal <Section> Acute Kidney Injury <Level> Synthesis/Evaluation 31. A 54-year-old man is admitted to the critical care unit with acute kidney injury resulting from a bladder tumor. This would be classified as which type of acute kidney injury? a. Prerenal b. Intrarenal—medullary c. Intrarenal—cortical d. Postrenal e. Correct answer: d Rationale: Postrenal failure is defined as an obstructive process that occurs distal to the kidney. Prerenal failure is caused by a decreased glomerular filtration rate resulting from decreased volume or pressure. Intrarenal failure is due to injury within the kidney. Intrarenal—cortical is caused by an infectious or inflammatory process within the kidney. Intrarenal—medullary is caused by prolonged ischemic injury or a nephrotoxin. Pre- means before, and post- means after. Postrenal renal failure logically would be renal failure caused by some problem after the kidney, such as tumor or stone. Test-Taking Strategy: Consider the anatomy of the renal system. The bladder is after (i.e., post) the kidney. <System> Renal <Section> Acute Kidney Injury <Level> Knowledge/Comprehension 32. A patient has gained 1 kg since yesterday. How much fluid does this weight gain represent? a. 250 mL b. 500 mL c. 1000 mL d. 2000 Ml e. Correct answer: c Rationale: One pound is equal to approximately 500 mL. One kilogram (2.2 lb) is equal to approximately 1 L. Test-Taking Strategy: None <System> Renal <Section> Fluid Balance <Level> Knowledge/Comprehension A 30-year-old man was electrocuted with 440 volts of electrical current. An entry wound was noted in his left hand, and a large exit wound was noted on the sole of his right foot. Eight hours after admission into the critical care unit, the nurse observes that the urine is brownish. A specimen is sent to the laboratory. What intervention is anticipated? a. Rapid fluid administration and dopamine at 2 mcg/kg/min b. Furosemide (Lasix) 10 mg IV and dopamine at 2 mcg/kg/min c. Rapid fluid administration and 25 g of 20% mannitol d. Insertion of a double-lumen vascular catheter and hemodialysis 20 circumstance? a. To reduce third-spacing b. To treat protein malnutrition c. To treat coagulopathy d. To reduce ammonia levels Correct answer: a Rationale: The liver’s inability to build plasma proteins results in hypoproteinemia in cirrhosis. The decrease in serum albumin (the primary intravascular protein) results in third-spacing manifested by ascites and peripheral edema. Replacing albumin will increase intravascular colloidal oncotic pressure to hold and pull fluid into the vascular space. Hypoproteinemia also contributes to coagulopathy; this is the result of the liver’s inability to produce adequate amounts of fibrinogen. Intravenous administration of albumin is not a treatment for malnutrition and it does not reduce ammonia levels. Test-Taking Strategy: Consider the patient’s clinical presentation and choose the option that is most directly related to the peripheral edema and ascites. <System> Renal <Section> Fluid Balance <Level> Application/Analysis A patient with chronic kidney disease asks why he is anemic. The explanation to this patient should be that anemia is the result of: a. loss of blood in the urine. b. inadequate production of a hormone that stimulates production of red blood cells. c. deficiency of iron needed for production of red blood cells. d. development of a gastric ulcer and blood loss as a result of the ulcer. Correct answer: b Rationale: Anemia in a patient with chronic kidney disease is caused by inadequate production of erythropoietin, a hormone that stimulates production of RBCs in the bone marrow. Test-Taking Strategy: None <System> Renal <Section> Chronic Kidney Disease <Level> Knowledge/Comprehension 37. patient with acute pancreatitis is experiencing muscle spasm. A prolonged QT interval is also noted on his ECG. Which of the following is a major concern with this patient? a. That he has hypermagnesemia and is at risk for respiratory arrest b. That he has hyperkalemia and is at risk for asystole c. That he has hypocalcemia and is at risk for dysrhythmias such as torsades de pointes d. That he has hyponatremia and is at risk for seizures Correct answer: c Rationale: Acute pancreatitis can cause significant hypocalcemia which is manifested by 21 tetany and prolonged QT interval. The prolonged QT interval predisposes the patient to torsades de pointes. Test-Taking Strategy: The electrolyte imbalance that occurs in acute pancreatitis is hypocalcemia and the muscle spasm and prolonged QT interval are consistent with hypocalcemia. Even though hypermagnesemia can cause respiratory arrest, hyperkalemia can cause asystole, and hyponatremia can cause seizures, these electrolyte imbalances are not consistent with the history and presentation. <System> Renal <Section> Electrolytes <Level> Application/Analysis An elderly man is admitted after several days of nausea, vomiting, and diarrhea. Which of the following would be most indicative of dehydration in this patient? a. Thirst, hypotension, bradycardia b. Hypotension, tachycardia, oliguria c. Thirst, tachycardia, dry mucous membranes d. Bradycardia, dry mucous membranes, oliguria Correct answer: b Rationale: Tachycardia, hypotension, oliguria, dry mucous membranes, and poor skin turgor would all be indications of dehydration. Even though thirst may be an indication of dehydration, it is frequently not seen in elderly patients, which makes option b preferred over option c. Test-Taking Strategy: With questions with multiple answers such as this one, use the True/False method with each answer in the option. So options a and d can easily be eliminated by the bradycardia in those options. With options b and c, you need to know how elderly patients vary in their clinical presentation of dehydration. <System> Renal <Section> Fluid Balance <Level> Synthesis/Evaluation 38. patient with a large amount of protein in the urine suggests damage to which portion of the nephron? a. Glomerulus b. Bowman’s capsule c. Proximal convoluted tubule d. Collecting duct Correct answer: a Rationale: Damage to the glomerulus causes loss of protein and proteinuria. Examples are glomerulonephritis, Goodpasture’s syndrome, and nephrotic syndrome. Test-Taking Strategy: Consider the glomerulus a semipermeable membrane. If it is damaged, it becomes more permeable allowing loss of protein and red blood cells. <System> Renal <Section> Fluid Balance <Level> Knowledge/Comprehension 22