The nurse is assessing an intubated client with a deep partial-thickness burn to the right leg and a circumferential full-thickness burn to the chest.
The nurse notes the SpO2 decreasing from 96 percent to 90 percent and high ventilator alarms. Which finding is most concerning to the nurse?

Pulmonary embolism disrupts the ventilation-perfusion ratio, leading to sudden hypoxemia and respiratory distress. Prioritizing interventions requires applying the airway, breathing, circulation framework. Knowledge of gas exchange and emergency protocols is necessary to stabilize the client and maintain systemic cellular oxygenation.

Choice A rationale

Oxygen administration is the priority to treat hypoxemia caused by the physiological dead space created by the embolism. Improving arterial oxygen saturation supports myocardial and cerebral function while reducing the workload of the right ventricle during obstruction.

Choice B rationale

Morphine acts as an analgesic and vasodilator which can reduce anxiety and preload. However, it does not address the primary physiological threat of impaired gas exchange. Breathing and oxygenation must be stabilized before managing pain or sedation.

Choice C rationale

Cardiac monitoring identifies arrhythmias and right-sided heart strain associated with pulmonary hypertension. While diagnostic, it is a secondary action that follows the restoration of oxygenation. Assessment tools should not delay the implementation of life-saving oxygen therapy.

Choice D rationale

Lactated Ringer's is used for volume expansion and electrolyte replacement. In pulmonary embolism, excessive fluid can worsen right ventricular failure and pulmonary edema. Circulatory support is important but remains secondary to correcting the immediate life-threatening respiratory deficit..

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..