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 C
Explanation
Choice A reason: Malignant prostatic hyperplasia is not a recognized medical term. Malignancy of the prostate refers to prostate cancer, which typically presents with elevated PSA levels and may include systemic symptoms or nodular findings on examination. This patient’s normal PSA and obstructive urinary symptoms point away from malignancy.
Choice B reason: Malignant prostatic hypertrophy is also not a standard diagnosis. Hypertrophy refers to enlargement, but when paired with “malignant,” it implies cancer. Again, the absence of elevated PSA and systemic signs makes this unlikely.
Choice C reason: Benign prostatic hyperplasia (BPH) is the most common cause of urinary symptoms in older men. It involves non-cancerous enlargement of the prostate gland, which compresses the urethra and impairs urine flow. Symptoms include frequency, hesitancy, weak stream, and incomplete emptying—all present in this case.
Choice D reason: Benign prostatic hypoplasia refers to underdevelopment of the prostate, which is rare and not associated with obstructive urinary symptoms. It does not fit the clinical presentation.
Correct Answer is D
Explanation
Choice A reason: Trichomonas is a sexually transmitted infection that typically causes vaginal discharge, itching, and irritation. It does not cause uterine tenderness or systemic symptoms like fever and flu-like illness in the postpartum period.
Choice B reason: A urinary tract infection may cause fever and abdominal discomfort, but it does not typically result in a tender, subinvoluted uterus or foul-smelling lochia. The symptoms described are more consistent with a uterine infection.
Choice C reason: Endometriosis is a chronic condition involving ectopic endometrial tissue, causing pelvic pain and infertility. It is not an acute postpartum infection and does not present with fever or foul-smelling discharge.
Choice D reason: Endometritis is an infection of the uterine lining, commonly occurring postpartum, especially after prolonged labor or cesarean delivery. Symptoms include uterine tenderness, fever, subinvolution, and malodorous lochia. This diagnosis best fits the clinical presentation.
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