A client with nephrotic syndrome is prescribed lisinopril.
Which statement by the client indicates a need for further teaching?
I should stop this medication if I notice swelling increases.
This medication will help reduce protein loss in my urine.
This medication helps protect my kidneys from further damage.
This medication will help control my blood pressure.
The Correct Answer is A
Management of nephrotic syndrome involves using ACE inhibitors for their antiproteinuric and renoprotective effects. One must understand the therapeutic goals of lisinopril in renal disease and the necessity of medication adherence and safety monitoring to provide accurate education.
Choice A rationale
Stopping lisinopril abruptly is dangerous and requires medical supervision. Patients must understand that swelling fluctuations should be reported to the provider rather than used as a reason to self-discontinue a critical medication for renal health.
Choice B rationale
Lisinopril, an ACE inhibitor, reduces the glomerular basement membrane permeability and lowers the pressure within the glomeruli. This action effectively decreases the amount of protein that leaks into the urine, which is a hallmark of syndrome.
Choice C rationale
By reducing intraglomerular pressure and decreasing proteinuria, ACE inhibitors help slow the progression of chronic kidney disease. This protective mechanism is vital for patients with nephrotic syndrome to preserve long-term renal function and prevent scarring.
Choice D rationale
Hypertension is a common complication and contributing factor in nephrotic syndrome. Lisinopril manages systemic blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, which prevents vasoconstriction and lowers the overall vascular resistance..
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Managing diabetic ketoacidosis involves addressing hyperglycemia, ketosis, and metabolic acidosis. Applying knowledge of insulin pharmacokinetics is essential, specifically identifying which insulin preparation is suitable for intravenous administration to rapidly reduce blood glucose and halt ketone production in emergencies.
Choice A rationale
Regular insulin is a short-acting preparation and the only insulin that can be administered intravenously. It rapidly lowers blood glucose and reverses ketoacidosis by inhibiting lipolysis. Onset is 30 to 60 minutes when given subcutaneously.
Choice B rationale
Insulin detemir is a long-acting basal insulin analog with a slow, steady release profile over 24 hours. It lacks a peak and cannot be given intravenously, making it inappropriate for the acute management of diabetic ketoacidosis.
Choice C rationale
NPH insulin is an intermediate-acting insulin containing protamine to delay absorption. It has an onset of 1 to 2 hours and is used for maintenance, not for the rapid correction of life-threatening metabolic acidosis.
Choice D rationale
Insulin glargine is a long-acting basal insulin that provides a constant concentration for 24 hours. It is used for long-term glycemic control and cannot be administered intravenously for emergent stabilization of diabetic ketoacidosis.
Correct Answer is ["A","B","C","D","E","F"]
Explanation
The scenario requires applying knowledge of anticoagulation pharmacology and safety protocols for pulmonary embolism management. Nurses must monitor therapeutic levels, maintain reversal agents, and assess for complications like bleeding to ensure systemic stability and prevent further clot propagation during recovery.
Choice A rationale
Activated partial thromboplastin time measures the intrinsic pathway of coagulation. It is vital for monitoring unfractionated heparin therapy, with a normal range of 30 to 40 seconds. Prolonged values indicate a higher risk for spontaneous hemorrhage.
Choice B rationale
Protamine sulfate acts as a specific antagonist to neutralize the anticoagulant effects of heparin. Availability is critical for immediate reversal if life threatening bleeding occurs or if the activated partial thromboplastin time exceeds the safe therapeutic range.
Choice C rationale
The international normalized ratio assesses the extrinsic pathway, primarily for warfarin therapy. A normal range for healthy individuals is 0.8 to 1.2, but therapeutic targets for pulmonary embolism typically fall between 2.0 and 3.0.
Choice D rationale
Hematocrit and platelet levels indicate bone marrow function and blood volume. Significant drops in hematocrit suggest internal bleeding, while platelet monitoring is essential to detect heparin induced thrombocytopenia, a serious immune mediated complication of anticoagulant use.
Choice E rationale
Phytonadione, or Vitamin K, is the essential reversal agent for warfarin induced anticoagulation. It promotes the hepatic synthesis of clotting factors 2, 7, 9, and 10, effectively counteracting excessive anticoagulation and reducing the risk of hemorrhage.
Choice F rationale
Continuous physical assessment is necessary to identify early signs of coagulopathy. These include petechiae, ecchymosis, hematuria, or bleeding gums. Early detection allows for prompt dosage adjustments or the administration of reversal agents to prevent clinical deterioration.
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