Exhibits

For each instruction, click to indicate whether the instructions given by the nurse are indicated or contraindicated to prepare for the client's first dose of captopril.

Increase the lantus dose by 3 units the morning of the first dose.

Limit fluids for several days before the first dose.

Hold spironolactone for 3 days.

Lay down if the blood pressure drops quickly after the first dose.

Monitor blood pressure for several hours after the first dose.

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Indicated Instructions:

Hold spironolactone for 3 days (Choice D):
- Reasoning: Captopril, an ACE inhibitor, can increase potassium levels. Spironolactone is a potassium-sparing diuretic. Holding spironolactone helps prevent hyperkalemia (high potassium levels), which can be dangerous.
Lay down if the blood pressure drops quickly after the first dose (Choice E):
- Reasoning: Captopril can cause a significant drop in blood pressure, especially after the first dose. Lying down helps prevent dizziness and fainting (orthostatic hypotension) due to the sudden decrease in blood pressure.

Contraindicated Instructions:

Increase the lantus dose by 3 units the morning of the first dose (Choice B):
- Reasoning: Adjusting insulin (Lantus) dose is not related to the administration of captopril and could potentially cause blood sugar imbalances. Such a change should be based on blood glucose monitoring, not the initiation of captopril.
Limit fluids for several days before the first dose (Choice C):
- Reasoning: Limiting fluids can lead to dehydration, which can exacerbate the hypotensive effects of captopril. Maintaining adequate hydration is important to avoid severe drops in blood pressure.
Monitor blood pressure for several hours after the first dose (Choice B):
- Reasoning: Monitoring blood pressure ensures that any significant hypotensive response (drop in blood pressure) to the initial dose of captopril is identified and managed promptly.

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Correct Answer is D

Explanation

Choice A rationale: Ingestion of Wort can reduce the client's intake of sodium: This information is not directly related to the situation of a renal transplant and graft rejection. It is not the most significant finding regarding the use of St. John's Wort in this context.

Choice B rationale: Adding the herb decreases the need for corticosteroids: There is no evidence or indication that St. John's Wort can decrease the need for corticosteroids, especially in the context of a renal transplant and graft rejection.

Choice C rationale: While St. John's Wort is sometimes used as an herbal remedy for depression, the most significant information, in this case, is its potential to interact with cyclosporine and affect the client's immunosuppressive medication. The focus should be on the drug interaction and the risk it poses to the client's graft health, rather than the reason for using the herb.

Choice D rationale: The most significant information about the finding that the client has been self-administering St. John's Wort is that it can decrease plasma concentrations of cyclosporine. Cyclosporine is an immunosuppressive medication commonly used after a renal transplant to prevent graft rejection. When St. John's Wort is taken concurrently with cyclosporine, it can induce certain liver enzymes responsible for drug metabolism, leading to a decreased concentration of cyclosporine in the bloodstream. This can potentially reduce the effectiveness of cyclosporine in preventing graft rejection, putting the client's transplanted kidney at risk.

A. Coagulation panels B. Cardiac enzymes C. Urine osmolality D. Kidney function test E. Electrolyte panel F. Complete blood count

Correct Answer is ["D","E"]

No explanation

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Exhibits For each instruction, click to indicate whether the instructions given by the nurse are indicated or contraindicated to prepare for the client's first dose of captopril.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Exhibits The provider would like the client to continue with the captopril dose and restart the spironolactone. The provider wants the client to return to the clinic in 6 weeks with lab work done. What 2 labs would be most appropriate for this client to complete on their return visit?

Correct Answer is ["D","E"]

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Exhibits

For each instruction, click to indicate whether the instructions given by the nurse are indicated or contraindicated to prepare for the client's first dose of captopril.