NR 507 / NR507 Advanced Pathophysiology Midterm Exam Study guide | Verified Answers | Latest Update 2026 / 2027 | Chamberlain University | Exam Review & Practice Questions

NR 507 / NR507 Advanced Pathophysiology Midterm Exam Study guide | Verified Answers | Latest Update 2026 / 2027 | Chamberlain University | Exam Review & Practice Questions Question: Which client should the nurse practitioner (NP) recognize as most at risk of developing iron deficiency anemia? A 25-year-old client who recently became pregnant A 40-year-old client with a history of peptic ulcers A 30-year-old client who donates blood every 3 months A 50-year-old client with congestive heart failure Answer A 30-year-old client who donates blood every 3 months Question: The nurse practitioner (NP) reviews a client's laboratory results. Which laboratory result best reflects the client's level of iron stores? Transferrin saturation Hemoglobin Serum iron Serum ferritin Hematocrit Total iron-binding capacity Answer Serum ferritin Question: The nurse practitioner (NP) is caring for a client with beta thalassemia major. The NP should anticipate the client will require what? Answer a bloos transfusion Question: The nurse practitioner (NP) is counseling a client with iron deficiency anemia about dietary needs. Which instruction(s) should the NP include? Select all that apply. Avoid drinking tea or coffee with meals Consume lean red meat Increase intake of calcium-rich foods Consume iron-fortified cereal Consume vitamin C-rich foods with iron-rich meals Avoid drinking tea or coffee with meals Answer Consume lean red meat Consume iron-fortified cereal Consume vitamin C-rich foods with iron-rich meals Question: A nurse practitioner (NP) is providing pre-conception counseling to a couple, both of whom are carriers of thalassemia. Which of the following actions should the NP take? Select all that apply. Encourage the couple not to conceive. Refer the couple for genetic counseling. Explain what it means to be a carrier of thalassemia. Discuss ways to prevent naturally conceiving a child with thalassemia. Discuss inheritance patterns of thalassemia. Answer Refer the couple for genetic counseling. Explain what it means to be a carrier of thalassemia. Discuss inheritance patterns of thalassemia. Question: The nurse practitioner (NP) assesses the client on a follow-up visit after the initiation of treatment for thalassemia including administration of blood transfusions. What three (3) assessments should the NP prioritize to evaluate client outcomes? Select 3. Dietary intake Developmental milestones Ferritin level Hemoglobin level Energy level Answer Ferritin level Hemoglobin level Energy level Question: Which of the following clients should the nurse practitioner (NP) recognize as being most at risk for developing vitamin B-12 deficiency anemia? An infant who is exclusively breastfed Middle adult client who eats a high-protein diet A client who is pregnant Adult client who had a vertical sleeve gastrectomy Answer Adult client who had a vertical sleeve gastrectomy Question: Mean Corpuscular Hemoglobin Concentration (MCHC) Answer indicates hemoglobin concentration in RBCs Question: Ferritin Answer total iron stores; low levels indicate iron deficiency Question: microlytic anemia Answer small RBC's -iron deficiency -thalassemia Thalassemia beta major treatment Answer blood transfusion- will increase iron stores Chelation therapy-deferasirox & deferiprone bone marrow transplant Question: Type 1 hypersensitivity Answer Mediated by IgE antibody Anaphylaxis, allergic rhinitis, asthma Question: Type 2 hypersensitivity Answer mediated by IgG antibodies and macrophages HITT reaction, transfusion reaction, Graves Disease Question: Graves disease Answer IgG antibodies attach the TSH receptor causing an over production of thyroid hormones leading the hyperthyroidism tx: beta blockers for tachycardia, methimazole (not for pregnant), propylthiouracil (for pregnant), radioactive iodine therapy (not for pregnant) Question: Type 3 hypersensitivity Answer neutrophil mediated reaction immune complexes activate complement system & neutrophils resulting in tissue destruction -Lupus, serum sickness systemic lupus erythematosus Answer B&T cells are over reactive causing production of antibodies DX with ANA antibody TX with NSAIDS for pain Which of the following client(s) should the nurse practitioner (NP) recognize as being at risk for developing folate deficiency? Select all that apply. A 30-year-old client with severe anorexia nervosa A 19-year-old client with sickle cell disease A 27-year-old client who is newly pregnant and breastfeeding their toddler A 40-year-old client with celiac disease A 32-year-old client who had a gastrectomy one year ago Answer A 30-year-old client with severe anorexia nervosa A 27-year-old client who is newly pregnant and breastfeeding their toddler A 40-year-old client with celiac disease What medications impact the absorption of B12 Answer Metformin, H2 receptor blockers, PPI What medications impact the absorption of folate Answer anticonvulsants and methotrexate A nurse practitioner (NP) evaluates a 45-year-old client who presents with fatigue and weakness. The NP diagnoses the client with anemia of chronic disease. What is the primary pathophysiological mechanism causing this normocytic anemia? Excessive blood loss Defective erythropoiesis Impaired iron absorption Delayed maturation of erythrocyte precursors Defective erythropoiesis A nurse practitioner (NP) evaluates a 28-year-old client who presents with fatigue, jaundice, and dark-colored urine. The NP diagnoses the client with hemolytic anemia. What is the most likely pathophysiological mechanism causing this normocytic anemia? Impaired iron absorption Excessive blood loss Defective erythropoiesis Increased red blood cell destruction Increased red blood cell destruction Which client should the nurse practitioner (NP) recognize as most at risk for developing hemolytic anemia? 60-year-old with a history of iron-deficiency anemia 35-year-old who recently underwent surgery for a bleeding ulcer 50-year-old who experienced a transfusion reaction after a blood transfusion 28-year-old with a family history of thalassemia 50-year-old who experienced a transfusion reaction after a blood transfusion The nurse practitioner (NP) evaluates a 30-year-old client with chronic kidney disease who presents with fatigue, weakness, and pallor. The laboratory results reveal a low hemoglobin, increased c-reactive protein, and increased erythrocyte sedimentation rate. The NP anticipates which additional laboratory finding? Reticulocyte count is not relevant to anemia assessment Decreased reticulocytes Increased reticulocytes Normal reticulocyte count Decreased reticulocytes A nurse practitioner (NP) is evaluating a client with a history of chronic kidney disease who reports symptoms of fatigue, weakness, and occasional shortness of breath. The client notes a gradual onset of these symptoms over the past few months. Which laboratory test(s) should the NP order? Select all that apply. C-reactive protein Erythrocyte sedimentation rate Ferritin level Basic metabolic panel Complete blood count C-reactive protein Erythrocyte sedimentation rate Ferritin level Complete blood count Hemolytic anemia labs low H&H, high bili, high reticulocytes, pos Coombs Which of the following best describes the primary pathophysiological mechanism underlying sickle cell disease? Altered synthesis of hemoglobin due to a mutation in the beta-globin gene Impaired immune response leading to frequent infections Abnormal clotting leading to vascular occlusion Dysregulated iron metabolism causing excessive iron deposition Altered synthesis of hemoglobin due to a mutation in the beta-globin gene which of these Findings are Consistent With Sickle Cell Disease Anemia? Joint pain Migraine headache Joint swelling Restricted range of motion Pallor Joint pain Joint swelling Restricted range of motion Pallor The nurse practitioner (NP) is counseling the parents of a child with sickle cell disease. Which of the following topics should the NP plan to include when educating the parents? Select all that apply. Hydroxyurea therapy Blood transfusion schedule Homeopathic remedies for a cure Vaccination schedule Pain management strategies Hydroxyurea therapy Blood transfusion schedule Vaccination schedule Pain management strategies A 28-year-old client with a history of sickle cell anemia presents to the emergency department with severe pain in the joints and abdomen, decreased range of motion in extremities, and decreased oxygen saturation levels. The client denies recent infections. The nurse practitioner (NP) should recognize the client is most likely experiencing which type of sickle cell crisis? Hyperhemolytic crisis Sequestration crisis Aplastic crisis Vaso-occlusive crisis Vaso-occlusive crisis A 35-year-old client with a known history of sickle cell anemia presents to the emergency department (ED) with jaundice, dark urine, and fatigue. Laboratory results show a significant drop in hemoglobin levels. The nurse practitioner (NP) should recognize the client is most likely experiencing which type of sickle cell crisis? Sequestration crisis Vaso-occlusive crisis Aplastic crisis Hemolytic crisis Hemolytic crisis What are the clinical manifestation associated with a vaso-occlusive crisis, aplastic crisis, sequestration crisis, or hyperhemolytic crisis? Bone pain → Vaso-occlusive crisis Dark-colored urine → Hyperhemolytic crisis Severe anemia → Aplastic crisis Splenomegaly → Sequestration crisis Which of the following pathophysiological condition(s) can lead to coronary artery disease (CAD)? Select all that apply. Hypertension Atrial fibrillation Heart failure Pneumonia Diabetes mellitus Gastroenteritis Diabetes mellitus Hypertension Which of the following diagnostic tests are used to confirm coronary artery disease (CAD)? Select all that apply. Cardiac catheterization Chest radiograph Orthostatic blood pressures Treadmill exercise stress test ST elevation on an electrocardiogram Cardiac catheterization & Treadmill exercise stress test An individual who is at risk for coronary artery disease may be prescribed which diagnostic tests? Select all that apply. Stress test Chest X-ray Echocardiogram Lipid profile Electrocardiogram ALL S/S of left sided heart failure Pulmonary congestion, orthopnea, hemoptasis S/S of right sided heart failure Anorexia, peripheral edema, JVD, hepatomegaly S/S of systolic HF reduced EF 40%, L vent hypertrophy, pull congestion with cardiomegaly, S3 gallop S/S of diastolic HF reduced EF 50%, decreased LV size, pull congestion without cardiomegaly on CXR, S4 gallop Tricuspid Valve o Located between the right atrium and right ventricle o Consists of three leaflets o During ventricular contraction, the tricuspid valve shuts to stop retrograde blood flow into the right atrium Aortic Valve o Located between the left ventricle and body o Semilunar valve has three cusps that open when the ventricles contract o During ventricular contraction, the aortic valve opens, allowing flow of blood to the body Bicuspid (Mitral) Valve o Located between the left atrium and left ventricle o Consists of two leaflets o During ventricular contraction, the mitral valve shuts to stop retrograde blood flow into the left atrium Pulmonary Valve o Located between the right ventricle and pulmonary artery o Semilunar valve has three cusps that open when the ventricles contract o During ventricular contraction, the pulmonic valve opens, allowing flow of blood into the pulmonary artery Aortic valave stenosis causes Rheumatic heart disease, congenital development or calcification Mitral valve stenosis causes valvular damage from infections and degenerative changes caused by calcium buildup S/S aortic stenosis exertional dyspnea, chest pain resembling angina, dizziness, or episodes of syncope, especially during physical activity,harsh, systolic ejection murmur best heard at the right upper sternal border, which may radiate to the neck, may have narrow pulse pressure S/S mitral stenosis A diastolic murmur at the fifth intercostal left midclavicular space, fatigue, shortness of breath, particularly with exertion or when lying flat (orthopnea), episodes of palpitations, and a history of rheumatic fever (or streptococcal infection). Mitral valve prolapse (MVP) dx and tx dx with echo, click on auscultation tx with BB for CP and palpitations, may need valve repair or replacement Which of the following best describes mitral regurgitation? Uneven closure of the valve flaps Calcification of the leaflet edges Retrograde flow through the valve Narrowing of the valve limiting forward flow Retrograde flow through the valve Which of the following is the most common cause of mitral stenosis? Congenital bicuspid valve Chordae tendineae damage after myocardial infarction Untreated streptococcal infection Calcification of the leaflets Untreated streptococcal infection Which of the following are the most common causes of aortic stenosis? Select all that apply. Insulin resistance Hypertension Calcification of the leaflets Congenital bicuspid valve Scar tissue caused by rheumatic fever Dyslipidemia Calcification of the leaflets Congenital bicuspid valve Scar tissue caused by rheumatic fever Which of the following are expected findings associated with mitral stenosis? Select all that apply. Diastolic murmur Atrial fibrillation Systolic murmur Left atrial enlargement Syncope Dependent edema Chest pain Diastolic murmur Atrial fibrillation Left atrial enlargement Which of the following may cause syncope in a client with aortic stenosis? Decreased oxygen saturation with increased myocardial oxygen demand Increased cardiac output with peripheral vasodilation Peripheral blood vessel vasoconstriction Inability to increase cardiac output during exertion Inability to increase cardiac output during exertion After confirming a diagnosis of aortic stenosis, which of the following is the most appropriate management strategy? Start beta-blocker therapy Refer for potential aortic valve replacement Start calcium channel blockers Monitor echocardiograms annually Refer for potential aortic valve replacement Which of the following outcomes indicate the effective management of aortic stenosis? Select all that apply. Increase in bone density Improvement in exercise tolerance Reduced symptoms of shortness of breath and dizziness Normal blood pressure No chest discomfort Improvement in exercise tolerance Reduced symptoms of shortness of breath and dizziness No chest discomfort Obstructive lung diseases COPD Asthma cystic fibrosis PE Pulmonary htn Restrictive lung diseases aspiration atelectasis bronchiectasis bronchiolitis pulmonary fibrosis pulmonary edema pneumoconiosis allergic alveolitis interstitial lung disease (ILD) acute respiratory distress syndrome (ARDS) Obstructive lung disease characteristics air trapping (CO2 retention) SOB on exhale tachypnea ventilation perfusion mismatch A V/Q mismatch is the imbalance between the air that enters the alveoli and the amount of perfusing blood, preventing the lungs from optimally delivering oxygenated blood throughout the body. Found in COPD patients V/Q mismatch s/s fatigue headache dizziness shortness of breath tachypnea confusion gray or bluish-tint to skin *acutely can cause edema and decrease UO Restrictive lung disease characteristics the inability to expand the lungs during inspiration and lung volume reduction causing dyspnea, tachypnea, and decreased tidal volume (TV). Pulmonary function tests (PFTs) can determine if a disease is restrictive or obstructive and the severity. Obstructive PFT findings Forced vital capacity (FVC)-Decreased or normal Forced expiratory volume in 1 second (FEV1): decreased FEV1/FVC ratio: Less than 70% Total lung capacity (TLC): 120% (represents hyperinflation) Restrictive PFT findings Forced vital capacity (FVC)-Decreased Forced expiratory volume in 1 second (FEV1): decreased FEV1/FVC ratio: Normal or than 70% Total lung capacity (TLC): 80% Spirometry and Asthma Variability occurs with a FEV1/FEV of 70% or less than the lower limit of normal. ***Reversibility is a key differentiator of asthma. It is defined as a FEV1 that improves by 12% and 200 mL after using a bronchodilator Asthma Dx Methacholine (maCh) challenge = induce bronchoconstriction to reduce FEV1 + test (less than 8-16 mg/mL) = Airways ARE reactive The nurse practitioner (NP) is seeing a client with chronic bronchitis that needs spirometry on today's visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? Decreased forced expiratory flow (FEV1) Decreased lung compliance Decreased total lung capacity (TLC) Decreased diffusing capacity Decreased forced expiratory flow (FEV1) Which clients are at high risk for obstructive and restrictive lung disease? Select all that apply. An 11-year-old child living with a parent who smokes cigarettes A 45-year-old client with an acute exacerbation of asthma A 74-year-old client who is immobile living in an assisted living facility A 34-year-old client with chronic urinary tract infections A 54-year-old client with a diagnosis of iron deficiency anemia An 11-year-old child living with a parent who smokes cigarettes A 45-year-old client with an acute exacerbation of asthma A 74-year-old client who is immobile living in an assisted living facility A 54-year-old client with a diagnosis of iron deficiency anemia Which best describes the way oxygen and carbon dioxide move between the alveoli and capillaries? There is no pressure or concentration gradient present in the lungs. Gases move from a high pressure and concentration to a high pressure and concentration. Gases move from a low pressure and concentration to a high pressure and concentration. Gases move from a high pressure and concentration to a low pressure and concentration. Gases move from a high pressure and concentration to a low pressure and concentration. Which actions will help prevent gas exchange problems in the future? Select all that apply. Learning to swim Getting vaccinated against COVID-19 Using an air purifier indoors Smoking cessation Avoiding high levels of outdoor air pollution ALL Which are homeostatic mechanisms used by the body when there is a gas exchange problem? Select all that apply. Forcing respiratory muscles to work harder Increasing respiratory rate Increasing digestion Changing the pH of the blood Relaxing the diaphragm Forcing respiratory muscles to work harder Increasing respiratory rate Changing the pH of the blood Which are age-related changes that can alter gas exchange? Select all that apply. Increased respiration Cigarette smoke damage Increased surface area of alveoli Decrease in the volume of air inhaled Less elasticity in the alveoli Decrease in the volume of air inhaled Less elasticity in the alveoli Which classification of antibiotics will be prescribed for a client with gram-positive bacterial pneumonia? Macrolide Fourth-generation cephalosporin Azole Proton-pump inhibitor Macrolide Which of the following findings confirm a diagnosis of COPD? Select all that apply. Number of hospitalizations per year Electrocardiograph results Oximetry results History of smoking COPD Assessment Test (CAT) score Post-bronchodilator results Modified Medical Research Council (mMRC) dyspnea scale score Number of hospitalizations per year History of smoking COPD Assessment Test (CAT) score Post-bronchodilator results Modified Medical Research Council (mMRC) dyspnea scale score Which physiological process causes wheezing during an exacerbation of asthma? Air passing through narrowed bronchioles and mucus during exhalation Air passing enlarged tonsils into a narrowed trachea during inhalation Air passing through the nose due to partial blockage of the epiglottis Air passing through the alveoli filled with mucus during inhalation and exhalation Air passing through narrowed bronchioles and mucus during exhalation Which of the following pathophysiologic changes occur with advanced chronic obstructive pulmonary disease (COPD)? Select all that apply. Breakdown of elastic fibers by elastase causes alveoli to permanently inflate. Thickening of the bronchial walls leads to narrowed airways. Underinflation of the lungs occurs due to difficulty inhaling air. High pressure in the pulmonary system develops over time. Decreased production of secretions leads to increased bronchial flow. Breakdown of elastic fibers by elastase causes alveoli to permanently inflate. Thickening of the bronchial walls leads to narrowed airways. High pressure in the pulmonary system develops over time. Which area of the lung is most affected by asthma? Small bronchi or bronchioles Alveolar duct Primary bronchus Secondary bronchus Small bronchi or bronchioles During an asthma attack, which of the following best describes the pathophysiologic process? The bronchus is narrowed by an obstruction, making inhalation difficult. The bronchioles are narrowed by an inflammatory response, making exhalation difficult. Blood clotting in the capillaries prevents oxygen from moving away from the lungs. The bronchioles are narrowed by an infectious response, making exhalation difficult. The bronchioles are narrowed by an inflammatory response, making exhalation difficult. Which of the following best describes the pathophysiology of interstitial lung disease? Characterized by the formation of granulomas in the alveoli Primarily caused by bacterial infections in the lung tissue Involves inflammation and scarring of the lung interstitium Result of chronic bronchial constriction and airway obstruction Involves inflammation and scarring of the lung interstitium Which client should the nurse practitioner (NP) recognize as being most at risk for developing interstitial lung disease? A 50-year-old female with a history of hypertension A 55-year-old male with a history of gastroesophageal reflux disease (GERD) A 60-year-old male with a history of exposure to asbestos A 30-year-old female with a history of allergic rhinitis A 60-year-old male with a history of exposure to asbestos The nurse practitioner (NP) evaluates a client who presents with a persistent dry cough, fatigue, and shortness of breath. The NP notes the client has clubbing of the fingers. Which of the following chest X-ray results does the NP anticipate? Patchy consolidations Presence of air in the pleural space Presence of fluid in the pleural space Bilateral reticular opacities and honeycombing Bilateral reticular opacities and honeycombing which three complications is a client with interstitial lung disease most at risk for developing. Select three. Pulmonary hypertension Stroke Respiratory failure Cor pulmonale Myocardial infarction Pulmonary hypertension Respiratory failure Cor pulmonale Which of the following are related to sarcoidosis? Select all that apply. Formation of granulomas Associated with occupational asbestos exposure Systemic inflammatory disease May affect the skin Predominantly affects the large airways Formation of granulomas Systemic inflammatory disease May affect the skin Conditions contributing to prerenal failure hypovolemia hypotension-poor perfusion obstruction to the renal artery ACE, ARBs and NSAID use Conditions contributing to intrarenal (or intrinsic renal) failure unresolved pre renal AKI nephrotoxic injury- contrast, chemo glomerular damage-infection, autoimmune causes interstitial injury-pyelonephritis Conditions contributing to postrenal failure kidney stone BPH stricture neurogenic bladder Risk factors for lower urinary tract infection catheter use famle gender Age Sexual activity Dehydration poor hygiene Risk factors for infections that originate in the upper urinary tract suppressed immune system urinary tract abnormalities or obstruction Complicated Urinary Tract Infection Characteristics o Altered urinary tract function o Decreased renal function o Increased risk for permanent renal damage or sepsis o Presence of white blood cell (WBC) casts o Presence of systemic symptoms (e.g., fever; lethargy; nausea or vomiting; back, flank, or abdominal pain) o Presence of blood in the urine o Requires intravenous (IV), followed by oral, antibiotics o Or no response to IV antibiotics o More than 3 UTIs in a year or 2 occurrences in 6 months is classified as a recurrent UTI Uncomplicated Urinary Tract Infection Characteristics o Normal urinary tract function o Normal renal function o Lower risk for permanent renal damage or sepsis o Absence of white blood cell (WBC) casts o Presence of local symptoms (e.g., pain or burning with urination; foul-smelling, cloudy urine) o Requires no treatment if asymptomatic o Requires oral antibiotics if symptomatic or a client is pregnant Risk Factors for developing BPH age greater than 50 years smoking and alcohol use sedentary lifestyle, obesity high-fat, high-protein, low-fiber diet chronic disorders, such as dm & cardiovascular disease Which of the following are upper urinary tract infections (UTIs)? Select all that apply. Urethritis Cystitis Prostatitis Ureter infection Pyelonephritis Ureter infection Pyelonephritis Which of the following screening tests for benign prostatic hypertrophy (BPH) are indicated for complaints of lower urinary tract symptoms (LUTS) in the aging male? Select all that apply. International Prostate Symptom Score (IPSS) Digital rectal examination of the prostate Prostate-specific antigen (PSA) level Screening colonoscopy Urinalysis International Prostate Symptom Score (IPSS) Urinalysis The nurse practitioner (NP) should educate the client that untreated benign prostatic hypertrophy (BPH) can lead to which of the following alterations in health? Select all that apply. Bowel obstruction Chronic kidney insufficiency Bladder stones Erectile dysfunction Urinary tract infection Prostate cancer Chronic kidney insufficiency Bladder stones Erectile dysfunction Urinary tract infection Which factor is most associated with the formation of renal calculi? High fluid intake Low calcium diet Reduced phosphate levels Decreased urine volume Decreased urine volume Which statements are true about the composition of renal calculi? Select all that apply. Cystine stones can occur due to an autosomal recessive genetic defect. Uric acid stones can be associated with gout. Calcium stones are linked to low urine pH. Struvite stones typically form in alkaline urine. Calcium stones can be associated with hyperparathyroidism. Cystine stones can occur due to an autosomal recessive genetic defect. Uric acid stones can be associated with gout. Struvite stones typically form in alkaline urine. Calcium stones can be associated with hyperparathyroidism. For the long-term prevention of calcium-based renal calculi, which educational strategies should the nurse practitioner (NP) reinforce? Select all that apply. Decrease sodium intake to help reduce calcium excretion in the urine. Increase fluid intake to produce at least 2 liters of urine per day. Maintain a balanced calcium intake without additional supplementation. Limit animal protein to reduce the risk of stone formation. Increase consumption of oxalate-rich foods such as spinach and nuts. Decrease sodium intake to help reduce calcium excretion in the urine. Increase fluid intake to produce at least 2 liters of urine per day. Maintain a balanced calcium intake without additional supplementation. Limit animal protein to reduce the risk of stone formation. Which physiologic process will relax the detrusor muscle? Activation of the muscarinic (M3) receptors by the sympathetic nervous system Activation of beta-2 (β-2) receptors by the sympathetic nervous system Activation of the muscarinic (M3) receptors by the parasympathetic nervous system Inhibition of the beta-2 (β-2) receptors by the sympathetic nervous system Activation of beta-2 (β-2) receptors by the sympathetic nervous system Which area of the brain contributes to the regulation of urination? Pontine micturition center Frontal lobe Cerebellum Hypothalamic relay center Pontine micturition center A nurse practitioner (NP) is evaluating a 40-year-old female named Jamila Akebdani (pronouns she/her/hers). Jamila has a history of systemic lupus erythematosus (SLE) and presents with complaints of fatigue and decreased urine output over the past week. She also reports a recent flare-up of SLE symptoms, including joint pain and a butterfly rash on the face. Jamila's vital signs are normal; laboratory studies indicate elevated blood urea nitrogen (BUN) and creatinine, elevated antinuclear antibody (ANA) titers, and proteinuria and hematuria in the urinalysis. Considering the client's history of SLE and current symptoms, which of the following is the most likely cause of acute kidney injury (AKI) in this client? Intrarenal (intrinsic) AKI due to heart failure Prerenal AKI due to dehydration Intrarenal (intrinsic) AKI due to lupus nephritis Postrenal AKI due to urinary tract obstruction Intrarenal (intrinsic) AKI due to lupus nephritis LeRoy Jones (pronouns he/him/his), 51 years old, presents for an annual wellness visit. He has a history of chronic kidney disease (CKD) secondary to diabetes mellitus. Vital signs are BP 126/82, P 78, R 18, serum albumin 65 mg/g, hemoglobin A1C 5.6%. Based on the 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease, the nurse practitioner (NP) selects which of the following treatments for LeRoy? Initiating ACE inhibitor medication Initiating peritoneal dialysis Discontinuing the metformin prescription Increasing the metformin dose Initiating ACE inhibitor medication