Nephrotic Syndrome

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Question 1: A nurse is caring for a client diagnosed with nephrotic syndrome who presents with edema, proteinuria, hypoalbuminemia, and hyperlipidemia. What is the priority nursing intervention for this client?

Explanation

A. Correct. Nephrotic syndrome is characterized by increased protein loss in the urine, leading to hypoalbuminemia and a weakened immune system. Clients with nephrotic syndrome are at a higher risk of infection, so the priority nursing intervention is to assess for signs of infection and initiate appropriate treatment promptly.

B. Incorrect. While monitoring blood glucose levels is essential in some conditions, it is not the priority for a client with nephrotic syndrome.

C. Incorrect. Dietary education may be necessary, but increasing protein intake is not appropriate for clients with nephrotic syndrome due to the increased protein loss in the urine.

D. Incorrect. Diuretics may be used to manage edema in nephrotic syndrome, but the priority intervention is to assess for infection, as it poses a more immediate threat to the client's health.


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Question 2: A client with nephrotic syndrome is prescribed corticosteroids as part of the treatment plan. What should the nurse include in the client's education about corticosteroid therapy?

Explanation

A. Incorrect. Corticosteroids should be taken with food to reduce the risk of gastrointestinal side effects.

B. Incorrect. While corticosteroids may improve proteinuria over time, it is unlikely to see an immediate improvement after starting the medication.

C. Correct. Corticosteroids can suppress the immune system and increase the risk of infection, so the client should avoid crowded places and contact with individuals who are sick to minimize the risk of infections.

D. Incorrect. Corticosteroids do not specifically affect potassium levels, so there is no need for a diet high in potassium to offset potential electrolyte imbalances.


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Question 3: A client with nephrotic syndrome is experiencing severe edema and hypoalbuminemia. Which nursing intervention is essential to manage the client's edema?

Explanation

A. Incorrect. Restricting fluid intake may not be appropriate for clients with nephrotic syndrome, as they may already have reduced fluid intake due to decreased glomerular filtration.

B. Incorrect. Elevating the client's legs can help reduce edema, but a low-sodium diet is a more direct and essential intervention for managing fluid retention in nephrotic syndrome.

C. Correct. A low-sodium diet is crucial in managing edema in nephrotic syndrome. Sodium intake can lead to fluid retention, and reducing sodium intake helps decrease edema.

D. Incorrect. Monitoring blood glucose levels is important for clients with diabetes, but it is not directly related to managing edema in nephrotic syndrome.


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Question 4: A nurse is assessing a client with nephrotic syndrome and notes frothy, foamy urine output. What is the rationale for this characteristic urine appearance?

Explanation

A. Incorrect. Frothy, foamy urine is not characteristic of increased glucose levels in the urine.

B. Incorrect. While blood in the urine may cause changes in urine color, it does not result in frothy, foamy appearance.

C. Correct. Nephrotic syndrome is characterized by increased protein excretion in the urine (proteinuriA. . The presence of protein in the urine can cause it to appear frothy and foamy.

D. Incorrect. Creatinine levels reflect kidney function, but they do not cause changes in urine appearance.


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Question 5: A client with nephrotic syndrome is prescribed angiotensin-converting enzyme (ACE. inhibitors. What is the purpose of ACE inhibitors in managing nephrotic syndrome?

Explanation

A. Correct. ACE inhibitors are commonly prescribed in nephrotic syndrome to reduce proteinuria by dilating blood vessels and decreasing pressure in the glomerulus. This helps preserve kidney function and slow the progression of kidney damage.

B. Incorrect. ACE inhibitors are not primarily used to manage blood glucose levels in diabetes, although they may have some impact on blood pressure control in clients with both diabetes and nephrotic syndrome.

C. Incorrect. ACE inhibitors do not directly impact calcium absorption or bone health in nephrotic syndrome.

D. Incorrect. ACE inhibitors do not specifically increase potassium excretion. In fact, they may lead to potassium retention, so clients may need to be cautious about potassium intake while on ACE inhibitors.


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Question 6: A nurse is caring for a client with nephrotic syndrome who is prescribed diuretics. What should the nurse monitor closely while the client is on diuretic therapy?

Explanation

A. Correct. Diuretics can lead to potassium loss, potentially causing hypokalemia. Monitoring serum potassium levels is essential to prevent complications related to potassium imbalances.

B. Incorrect. Diuretics may affect blood glucose levels indirectly, but their primary impact is not related to glucose control.

C. Incorrect. Diuretics do not directly impact calcium levels

in nephrotic syndrome.

D. Incorrect. While monitoring blood pressure is important in nephrotic syndrome, it is not the primary focus when clients are on diuretic therapy.


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Question 7: A client with nephrotic syndrome is prescribed anticoagulant therapy. What is the rationale for administering anticoagulants in nephrotic syndrome?

Explanation

A. Incorrect. While increased proteinuria can increase the risk of clot formation in the urinary tract, anticoagulant therapy is not typically prescribed for this reason in nephrotic syndrome.

B. Incorrect. Anticoagulants are not primarily used to reduce inflammation and pain associated with kidney damage.

C. Incorrect. Anticoagulants do not directly impact the risk of infection related to hypoalbuminemia.

D. Correct. Nephrotic syndrome can cause damage to the glomerular capillaries, leading to clot formation. Anticoagulant therapy is prescribed to prevent clot formation in the kidneys and reduce the risk of complications such as renal vein thrombosis.

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Question 8: A nurse is assessing a client with suspected nephrotic syndrome. Which finding should the nurse expect to observe?

Explanation

A. Incorrect. Hematuria (blood in the urinE. and dysuria (painful urination) are not characteristic manifestations of nephrotic syndrome. Instead, they may indicate other kidney conditions or infections.

B. Incorrect. While clients with nephrotic syndrome may experience increased urine output (polyuriA. and nighttime urination (nocturiA. due to fluid imbalances, these are not the primary clinical manifestations.

C. Correct. Frothy, foamy urine output is a classic sign of nephrotic syndrome due to the presence of excessive protein (proteinuriA. in the urine. This foamy appearance is caused by the high levels of protein, mainly albumin, in the urine.

D. Incorrect. Suprapubic tenderness and urgency are not typical manifestations of nephrotic syndrome and may indicate other urinary tract or bladder issues.


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Question 9: A client with nephrotic syndrome reports experiencing generalized edema. What is the underlying pathophysiological reason for the client's edema?

Explanation

A. Incorrect. Increased renal blood flow and fluid overload would lead to excessive urine output and reduced edema, which is not consistent with nephrotic syndrome.

B. Incorrect. Excessive sodium excretion and dehydration would lead to reduced fluid retention and edema, which is not consistent with nephrotic syndrome.

C. Correct. Nephrotic syndrome is characterized by glomerular damage, leading to increased permeability of the glomerular capillaries and loss of protein (mainly albumin) in the urine. This results in decreased oncotic pressure in the blood vessels, leading to edema in various parts of the body.

D. Incorrect. Elevated blood pressure and vascular leakage would lead to a different set of clinical manifestations, not characteristic of nephrotic syndrome.


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Question 10: A client with nephrotic syndrome presents with periorbital edema. Which additional assessment finding should the nurse anticipate?

Explanation

A. Correct. Periorbital edema is a common manifestation of nephrotic syndrome, especially in the morning after fluid accumulation overnight. Elevated blood pressure and headache may accompany this edema, indicating fluid retention and hypertension, which are frequently associated with nephrotic syndrome.

B. Incorrect. Yellowish discoloration of the skin and sclera (jaundicE. is not a typical manifestation of nephrotic syndrome and is more indicative of liver dysfunction or bile flow obstruction.

C. Incorrect. Pain and tenderness over the lower back are not directly related to periorbital edema and may suggest a separate issue, such as musculoskeletal pain.

D. Incorrect. Shortness of breath and crackles in the lungs are not specific to nephrotic syndrome and may suggest other respiratory or cardiac issues.


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Question 11: A nurse is assessing a client with nephrotic syndrome for signs of hypoalbuminemia. What clinical manifestation should the nurse expect to observe?

Explanation

A. Incorrect. Elevated blood pressure and fluid overload are more indicative of fluid retention and hypertension in nephrotic syndrome, not hypoalbuminemia.

B. Correct. Hypoalbuminemia, a common feature of nephrotic syndrome, results from the loss of albumin (a protein) in the urine. Low albumin levels can lead to muscle weakness and fatigue due to decreased oncotic pressure in the blood vessels, resulting in fluid shifting from the blood vessels to the interstitial spaces.

C. Incorrect. Hyperactivity and restlessness are not typical manifestations of hypoalbuminemia and nephrotic syndrome.

D. Incorrect. Pallor and cold extremities are not directly related to hypoalbuminemia and are not specific to nephrotic syndrome.


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Question 12: A client with nephrotic syndrome is at increased risk of developing thromboembolic events. What is the underlying pathophysiological reason for this increased risk?

Explanation

A. Incorrect. Elevated platelet count and clotting factors are not characteristic of nephrotic syndrome. Clients with nephrotic syndrome tend to have normal platelet counts.

B. Incorrect. Decreased blood viscosity and enhanced blood flow would not directly lead to an increased risk of thromboembolic events in nephrotic syndrome.

C. Incorrect. While impaired liver function may impact clotting factors, it is not a common manifestation of nephrotic

syndrome.

D. Correct. Nephrotic syndrome is associated with a loss of anticoagulant proteins, particularly antithrombin III, in the urine. This loss of anticoagulant proteins contributes to a state of hypercoagulability, increasing the risk of thromboembolic events, such as deep vein thrombosis and pulmonary embolism.


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Question 13: A nurse is caring for a client with nephrotic syndrome who develops abdominal distension and discomfort. What complication should the nurse suspect based on these manifestations?

Explanation

A. Incorrect. Abdominal distension and discomfort are not typical manifestations of a urinary tract infection, even in the presence of proteinuria.

B. Correct. Nephrotic syndrome often results in hypoalbuminemia due to significant protein loss in the urine. Hypoalbuminemia leads to decreased oncotic pressure in the blood vessels, causing fluid to leak into the peritoneal cavity and resulting in abdominal distension and discomfort, known as ascites.

C. Incorrect. Hyperkalemia may occur in chronic kidney disease, including nephrotic syndrome, but it is not directly related to abdominal distension and discomfort.

D. Incorrect. Renal vein thrombosis is a complication of nephrotic syndrome but is not typically associated with acute abdominal distension and discomfort.


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Question 14: A client with nephrotic syndrome is experiencing hyperlipidemia. What is the rationale for elevated lipid levels in this client?

Explanation

A. Incorrect. While increased cholesterol synthesis in the liver can contribute to hyperlipidemia, it is not the primary reason for elevated lipid levels in nephrotic syndrome.

B. Incorrect. Impaired fat absorption in the small intestine is not a significant factor contributing to hyperlipidemia in nephrotic syndrome.

C. Correct. Nephrotic syndrome results in increased protein loss, including proteins involved in lipid transport and metabolism. Reduced clearance of lipids by the kidneys leads to elevated lipid levels in the bloodstream.

D. Incorrect. Elevated blood glucose levels and insulin resistance are not directly related to hyperlipidemia in nephrotic syndrome.

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Question 15: A client with suspected nephrotic syndrome is scheduled for a renal biopsy. What is the primary purpose of a renal biopsy in diagnosing nephrotic syndrome?

Explanation

A. Incorrect. While a renal biopsy may provide information about kidney function and glomerular filtration rate, its primary purpose in diagnosing nephrotic syndrome is to identify the specific histopathological changes in the kidney, which can help confirm the diagnosis and guide treatment decisions.

B. Incorrect. The response to diuretic therapy can be monitored through other means, such as assessing urine output and fluid balance. A renal biopsy is not performed primarily to evaluate the response to diuretics.

C. Incorrect. Renal biopsy is not typically used to evaluate the extent of renal inflammation and infection. Other imaging or laboratory tests are more suitable for assessing renal inflammation and infection.

D. Correct. A renal biopsy is the definitive diagnostic procedure for nephrotic syndrome. It allows the pathologist to examine a small tissue sample from the kidney and identify the specific histopathological changes, such as glomerular changes, that confirm the diagnosis.


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Question 16: A nurse is reviewing a client's laboratory results and notes a decreased serum albumin level. What is the significance of decreased serum albumin in diagnosing nephrotic syndrome?

Explanation

A. Incorrect. Decreased serum albumin levels may contribute to fluid overload and hypertension in nephrotic syndrome, but they are not the primary indicators of these complications.

B. Incorrect. A decreased serum albumin level alone does not confirm the presence of proteinuria, which requires additional tests, such as a 24-hour urine collection for protein quantification.

C. Incorrect. Decreased serum albumin levels are not directly related to the presence of renal vein thrombosis, although nephrotic syndrome can increase the risk of thromboembolic events.

D. Correct. In nephrotic syndrome, the glomerular damage results in significant proteinuria, leading to decreased serum albumin levels. The loss of albumin in the urine contributes to hypoalbuminemia, a hallmark feature of nephrotic syndrome.


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Question 17: A nurse is assisting with a 24-hour urine collection for a client suspected of having nephrotic syndrome. What does this test assess?

Explanation

A. Incorrect. Glomerular filtration rate and kidney function are typically assessed through blood tests, such as serum creatinine and blood urea nitrogen (BUN) levels. A 24-hour urine collection is not used to assess these parameters.

B. Incorrect. The presence of glucose and ketones in the urine is typically assessed using a urinalysis or dipstick test. A 24-hour urine collection is not used to determine glucose and ketone levels.

C. Correct. A 24-hour urine collection measures the amount of protein excreted in the urine over a 24-hour period. This test is essential in diagnosing and monitoring nephrotic syndrome, as significant proteinuria is a hallmark feature of the condition.

D. Incorrect. The concentration of electrolytes in the urine is not typically assessed through a 24-hour urine collection. Urinary electrolyte levels are more commonly evaluated through spot urine samples or blood tests.


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Question 18: A client with nephrotic syndrome is undergoing a blood test to assess serum lipid levels. What is the rationale for monitoring lipid levels in this client?

Explanation

A. Incorrect. Monitoring lipid levels is not primarily aimed at identifying liver dysfunction in clients with nephrotic syndrome.

B. Incorrect. While nephrotic syndrome can lead to secondary diabetes mellitus in some cases, monitoring lipid levels is not a direct indicator of diabetes.

C. Correct. Nephrotic syndrome is associated with increased levels of lipids, including cholesterol and triglycerides, in the blood (hyperlipidemiA. . Monitoring lipid levels helps detect this common complication of nephrotic syndrome and informs treatment decisions.

D. Incorrect. Monitoring lipid levels is not directly related to evaluating electrolyte imbalances in clients with nephrotic syndrome. Electrolyte imbalances are typically assessed through separate blood tests.

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Question 19: A nurse is caring for a client with nephrotic syndrome who presents with severe edema and hypoalbuminemia. What is the priority nursing intervention for this client?

Explanation

A. Correct. Diuretics are commonly used to manage edema in clients with nephrotic syndrome. They help increase urine output and reduce fluid retention, which can alleviate severe edema and fluid overload.

B. Incorrect. Restricting fluid intake is not typically recommended for clients with nephrotic syndrome, as it may lead to dehydration and worsen the hypoalbuminemia.

C. Incorrect. While adequate protein intake is essential, a high-protein diet may not be appropriate for clients with nephrotic syndrome due to increased protein loss in the urine.

D. Incorrect. Monitoring blood glucose levels is important, but it is not directly related to managing edema and hypoalbuminemia in nephrotic syndrome.


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Question 20: A client with nephrotic syndrome is prescribed corticosteroids as part of the treatment plan. What should the nurse include in the client's education about corticosteroid therapy?

Explanation

A. Incorrect. Corticosteroids should be taken with food to reduce the risk of gastrointestinal side effects.

B. Incorrect. While corticosteroids may improve proteinuria over time, it is unlikely to see an immediate improvement after starting the medication.

C. Correct. Corticosteroids can suppress the immune system and increase the risk of infection, so the client should avoid crowded places and contact with individuals who are sick to minimize the risk of infections.

D. Incorrect. Corticosteroids do not specifically affect potassium levels, so there is no need for a diet high in potassium to offset potential electrolyte imbalances.


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Question 21: A nurse is planning dietary interventions for a client with nephrotic syndrome. What dietary modification is essential to reduce edema in this client?

Explanation

A. Incorrect. Increasing sodium intake would worsen edema and fluid retention in clients with nephrotic syndrome, as sodium contributes to fluid retention.

B. Incorrect. While protein intake may need to be adjusted in nephrotic syndrome, a low-protein diet is not typically indicated, as clients may already have protein loss in the urine.

C. Incorrect. Encouraging fluid restriction is not recommended in nephrotic syndrome, as it may lead to dehydration and worsen edema due to hypoalbuminemia.

D. Correct. A low-sodium diet is crucial in managing edema in nephrotic syndrome. Sodium intake can lead to fluid retention, and reducing sodium intake helps decrease edema.


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Question 22: A nurse is caring for a client with nephrotic syndrome who is prescribed angiotensin-converting enzyme (ACE. inhibitors. What is the purpose of ACE inhibitors in managing nephrotic syndrome?

Explanation

A. Correct. ACE inhibitors are commonly prescribed in nephrotic syndrome to reduce proteinuria by dilating blood vessels and decreasing pressure in the glomerulus. This helps preserve kidney function and slow the progression of kidney damage.

B. Incorrect. ACE inhibitors are not primarily used to manage blood glucose levels in diabetes, although they may have some impact on blood pressure control in clients with both diabetes and nephrotic syndrome.

C. Incorrect. ACE inhibitors do not directly impact calcium absorption or bone health in nephrotic syndrome.

D. Incorrect. ACE inhibitors do not specifically increase potassium excretion. In fact, they may lead to potassium retention, so clients may need to be cautious about potassium intake while on ACE inhibitors.


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Question 23: A client with nephrotic syndrome is at increased risk of developing thromboembolic events. What is the underlying pathophysiological reason for this increased risk?

Explanation

A. Incorrect. Elevated platelet count and clotting factors are not characteristic of nephrotic syndrome. Clients with nephrotic syndrome tend to have normal platelet counts.

B. Incorrect. Decreased blood viscosity and enhanced blood flow would not directly lead to an increased risk of thromboembolic events in nephrotic syndrome.

C. Incorrect. While impaired liver function may impact clotting factors, it is not a common manifestation of nephrotic syndrome.

D. Correct. Nephrotic syndrome is associated with a loss of anticoagulant proteins, particularly antithrombin III, in the urine. This loss of anticoagulant proteins contributes to a state of hypercoagulability, increasing the risk of thromboembolic events, such as deep vein thrombosis and pulmonary embolism.


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Question 24: A nurse is caring for a client with nephrotic syndrome who is experiencing hyperlipidemia. What is the rationale for elevated lipid levels in this client?

Explanation

A. Incorrect. While increased cholesterol synthesis in the liver can contribute to hyperlipidemia, it is not the primary reason for elevated lipid levels in nephrotic syndrome.

B. Incorrect. Impaired fat absorption in the small intestine is not a significant factor contributing to hyperlipidemia in nephrotic syndrome.

C. Correct. Nephrotic syndrome results in increased protein loss, including proteins involved in lipid transport and metabolism. Reduced clearance of lipids by the kidneys leads to elevated lipid levels in the bloodstream.

D. Incorrect. Elevated blood glucose levels and insulin resistance are not directly related to hyperlipidemia in nephrotic syndrome.

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Question 25: A nurse is educating a client with nephrotic syndrome about self-management strategies. Which statement by the client indicates the need for further teaching?

Explanation

A. Correct. Monitoring blood pressure regularly is essential for clients with nephrotic syndrome, as they are at risk of hypertension due to fluid retention.

B. Incorrect. Restricting fluid intake is not typically recommended for clients with nephrotic syndrome, as it may lead to dehydration and worsen edema due to hypoalbuminemia.

C. Correct. Clients with nephrotic syndrome are at increased risk of infections due to immunosuppression from protein loss in the urine. Reporting any signs of infection is crucial to ensure timely intervention.

D. Correct. Daily weight monitoring is essential for clients with nephrotic syndrome to assess for fluid retention. Sudden weight changes can indicate worsening edema and fluid overload.


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Question 26: A client with nephrotic syndrome is prescribed corticosteroids. What potential side effects should the nurse include in the client's education about corticosteroid therapy?

Explanation

A. Incorrect. Increased urine output and dehydration are not common side effects of corticosteroid therapy. Instead, clients may experience fluid retention and edema due to the medication's effects.

B. Correct. Corticosteroids can cause increased appetite, leading to weight gain, which is a common side effect that clients should be aware of.

C. Incorrect. Frequent bruising and prolonged bleeding are not typical side effects of corticosteroids. Instead, clients on corticosteroid therapy may experience increased susceptibility to infections and impaired wound healing.

D. Incorrect. Corticosteroids are more likely to cause fluid retention and increased blood pressure, leading to potential hypertension, rather than low blood pressure and dizziness.


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Question 27: A nurse is planning discharge education for a client with nephrotic syndrome. What should be included in the client's dietary education?

Explanation

A. Incorrect. While protein intake may need to be adjusted in nephrotic syndrome, increasing protein intake is not typically recommended, as clients may already have significant protein loss in the urine.

B. Incorrect. Limiting potassium-rich foods is not a primary dietary concern in nephrotic syndrome. Clients should consume a balanced diet unless instructed otherwise by their healthcare provider.

C. Correct. A low-sodium diet is crucial in managing fluid retention and edema in clients with nephrotic syndrome. Sodium intake contributes to fluid retention, so reducing sodium intake helps decrease edema.

D. Incorrect. Restricting fluid intake is not typically recommended in nephrotic syndrome, as it may lead to dehydration and worsen fluid imbalances due to hypoalbuminemia.


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Question 28: A client with nephrotic syndrome is prescribed an angiotensin-converting enzyme (ACE. inhibitor. What should the nurse instruct the client to do while on this medication?

Explanation

A. Incorrect. While some clients on ACE inhibitors may need to be cautious about potassium intake, this instruction is not universally applicable to all clients with nephrotic syndrome on this medication.

B. Incorrect. ACE inhibitors should be taken with food to reduce the risk of gastrointestinal side effects.

C. Incorrect. Monitoring blood glucose levels is important, but it is not directly related to ACE inhibitor use in nephrotic syndrome.

D. Correct. ACE inhibitors can cause a drop in blood pressure, leading to dizziness, especially when changing positions (orthostatic hypotension). Clients should be instructed to change positions slowly to prevent falls and injuries.


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Question 29: A client with nephrotic syndrome is at an increased risk of infection. What measures should the nurse recommend to the client to reduce the risk of infection?

Explanation

A. Incorrect. While some clients may be at increased risk of certain infections, avoiding close contact with family members is not practical and not recommended in general.

B. Correct. Good hand hygiene is essential in reducing the risk of infections in clients with nephrotic syndrome, as they are immunocompromised due to protein loss in the urine. Regular handwashing with soap and water, especially before meals and after using the bathroom, can help prevent the spread of pathogens.

C. Incorrect. Avoiding outdoor activities and crowded places is not necessary for all clients with nephrotic syndrome and may negatively impact their quality of life.

D. Incorrect. While physical activity is generally beneficial for overall health, it is not directly related to enhancing the immune system's response in clients with nephrotic syndrome.


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Question 30: A nurse is caring for a client with nephrotic syndrome who is experiencing skin breakdown due to edema. What should the nurse prioritize in the client's care?

Explanation

A. Incorrect. While monitoring urine output and kidney function is important in nephrotic syndrome, it is not directly related to addressing skin breakdown.

B. Correct. Skin breakdown in clients with nephrotic syndrome can lead to an increased risk of infection. The nurse should assess the affected skin areas for signs of infection, such as redness, warmth, swelling, and drainage.

C. Incorrect. Providing pain medication may be necessary for managing discomfort, but the priority is to prevent infection and promote wound healing.

D. Incorrect. While reducing edema is important, it is not the immediate priority in managing skin breakdown and preventing infection.


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Question 31: A client with nephrotic syndrome is prescribed immunosuppressive medications. What is the rationale for using immunosuppressive drugs in the management of nephrotic syndrome?

Explanation

A. Correct. Immunosuppressive medications are prescribed in nephrotic syndrome to reduce inflammation in the kidneys and prevent further damage, including kidney scarring. They help slow the progression of the disease and preserve kidney function.

B. Incorrect. Immunosuppressive medications are not primarily used to address fluid overload or improve urinary output in nephrotic syndrome.

C. Incorrect. While some immunosuppressive medications may have an impact on blood glucose levels, they are not typically used to manage diabetes in nephrotic syndrome.

D. Incorrect. Immunosuppressive medications do not directly alleviate pain and discomfort associated with edema in nephrotic syndrome. Other interventions, such as diuretics, are used for managing edema.

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