A patient with reduced glomerular filtration has a blood pressure of 168/100 mm Hg. The nurse realizes that which of the following is occurring with this patient?
1. sluggish response by the renin-angiotensin system
2. rebound hypertension due to fluid volume deficit
3. increased renin production causing the retention of water and electrolytes
4. kidneys hyper-excreting hydrogen ions
3
Rationale: Hypertension is a common manifestation of renal failure. It is caused by systemic and central fluid volume excess and increased renin production. In the presence of renal ischemia, the renin-angiotensin system is triggered and not sluggish. The patient has fluid volume excess and not deficit. The kidneys are not able to excrete hydrogen ions or hyper-excreting hydrogen ions.
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