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.

Answer and Explanation

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..

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Correct Answer is A

Explanation

The clinical scenario involves a client experiencing neurological deficits from a transient ischemic attack who presents with specific pharmacological and chemical allergies. Applying knowledge of cross-sensitivity and radiopaque dye composition is essential to identify risks associated with iodine-based contrast media and morphine-codeine hypersensitivity.

Choice A rationale

Computed tomography scans with contrast utilize iodine-based dyes to enhance vascular visualization. Since the client has a documented iodine allergy, this order poses a significant risk of anaphylaxis or severe hypersensitivity reactions and requires urgent clarification with the provider.

Choice B rationale

Transient ischemic attacks are often linked to atherosclerosis and hypertension. A low-fat, low-cholesterol diet is a standard therapeutic intervention to manage lipid levels and prevent further plaque accumulation, making this a safe and appropriate non-pharmacological order.

Choice C rationale

Monitoring vital signs is a fundamental nursing responsibility during the acute phase of a neurological event. Frequent assessments help detect changes in blood pressure or heart rate, which are critical for maintaining cerebral perfusion and identifying potential deterioration.

Choice D rationale

Acetaminophen is a non-opioid analgesic that does not share chemical properties with morphine or codeine. Because it is not an opiate or salicylate, it is safe to administer for a headache in a patient allergic to opioids.

A. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg. B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg. C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg. D. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg.

Correct Answer is D

Explanation

This question requires knowledge of acid-base balance and pathophysiology of chronic kidney disease. Understanding how impaired renal function leads to metabolic acidosis through decreased hydrogen ion excretion and reduced bicarbonate regeneration is essential to identify the correct values.

Choice A rationale

A pH of 7.55 and HCO3 of 30 indicate metabolic alkalosis. Normal pH is 7.35 to 7.45 and HCO3 is 22 to 28 mEq/L. Renal failure typically results in acid accumulation, not excess base.

Choice B rationale

A pH of 7.30 and PaCO2 of 50 indicate respiratory acidosis. In renal failure, the lungs typically compensate for metabolic acid by hyperventilating to lower PaCO2, which is the opposite of the hypoventilation shown here.

Choice C rationale

A pH of 7.50 and PaCO2 of 32 indicate respiratory alkalosis. This state occurs when the patient hyperventilates excessively, leading to an alkaline pH, which does not align with the metabolic acidosis expected in renal disease.

Choice D rationale

Chronic kidney disease causes metabolic acidosis. A pH of 7.25 and HCO3 of 19 mEq/L demonstrate low pH and low bicarbonate. The PaCO2 of 30 mm Hg reflects respiratory compensation for the primary metabolic acid-base imbalance.

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A client with nephrotic syndrome is prescribed lisinopril. Which statement by the client indicates a need for further teaching?

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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A client with nephrotic syndrome is prescribed lisinopril.
Which statement by the client indicates a need for further teaching?