A 56-year-old patient with well-controlled type 2 diabetes and hypertension comes to the APRN for routine follow-up. His blood pressure is controlled with lisinopril 40 mg/day, but his albumin-to-creatinine ratio is 75 mg/g. The patient's records show that his albuminuria is getting progressively worse. The APRN wonders whether the combination of an angiotensin-converting enzyme (ACE) inhibitor and an ARB would slow the decline of renal function, and whether the combination would reduce the patient’s cardiovascular risk. What should the APRN implement in order to address the patient's albuminuria?
Add an angiotensin receptor blocker (ARB) to the medication regimen due to the potential benefits of a dual angiotensin blockade.
Add a thiazide diuretic.
Do nothing because his blood pressure is controlled.
Add a calcium channel blocker (CCB).
The Correct Answer is D
Choice A reason: Dual blockade with ACE inhibitors and ARBs has been studied but is not recommended due to increased risk of adverse effects such as hyperkalemia, hypotension, and acute kidney injury. It does not provide additional renal protection and may worsen outcomes.
Choice B reason: Thiazide diuretics are useful for blood pressure control, especially in volume overload, but they do not specifically address albuminuria. They are not the preferred agents for reducing proteinuria.
Choice C reason: Even though blood pressure is controlled, progressive albuminuria indicates ongoing renal damage. Doing nothing overlooks the need for targeted intervention to reduce proteinuria and preserve kidney function.
Choice D reason: Calcium channel blockers, particularly non-dihydropyridine types like verapamil or diltiazem, have shown benefit in reducing proteinuria. They can be added to ACE inhibitors to enhance renal protection without the risks associated with dual renin-angiotensin system blockade.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: H2 receptor antagonists such as ranitidine and famotidine are effective for mild GERD symptoms, but they are not considered first-line for moderate to severe GERD. PPIs are preferred due to their superior acid suppression and healing rates for erosive esophagitis.
Choice B reason: The American College of Gastroenterology recommends initiating PPI therapy once daily before the first meal of the day for GERD management. PPIs reduce gastric acid secretion by inhibiting the H+/K+ ATPase pump in parietal cells, providing effective symptom relief and mucosal healing.
Choice C reason: While some PPIs have undergone scrutiny for long-term safety concerns (e.g., risk of kidney disease, osteoporosis, and infections), they have not been widely recalled. Most remain approved and in use under proper clinical guidance.
Choice D reason: H2 receptor agonists do not exist; the correct term is H2 receptor antagonists. Moreover, they are less effective than PPIs for healing erosive GERD and maintaining remission, especially in severe cases.
Correct Answer is D
Explanation
Choice A reason: Levothyroxine is a synthetic form of thyroxine (T4) used to treat hypothyroidism. Administering this to a patient with signs of hyperthyroidism, such as exophthalmos, tremors, and hypertension, would worsen the condition.
Choice B reason: Liotrix is a combination of synthetic T4 and T3 hormones, also used to treat hypothyroidism. Like levothyroxine, it is contraindicated in hyperthyroid states and would exacerbate the symptoms.
Choice C reason: Liothyronine is synthetic T3 and is used in hypothyroidism or myxedema coma. It is not appropriate for treating hyperthyroidism and would intensify the patient’s symptoms.
Choice D reason: Propylthiouracil (PTU) is an antithyroid medication that inhibits thyroid hormone synthesis and peripheral conversion of T4 to T3. It is indicated in hyperthyroidism and Graves’ disease, especially when symptoms include goiter and exophthalmos. PTU helps reduce hormone levels and alleviate symptoms.
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