Author Question: The primary care NP is considering prescribing captopril (Capoten) for a patient. The NP learns that ... (Read 33 times)

sarasara · **on:** Jul 24, 2018

The primary care NP is considering prescribing captopril (Capoten) for a patient. The NP learns that the patient has decreased renal function and has renal artery stenosis in the right kidney. The NP should:

a. initiate ACE inhibitor therapy at a low dose.
b. consider a different drug class to treat this patient's symptoms.
c. give the captopril with a thiazide diuretic to improve renal function.
d. order lisinopril (Zestril) instead of captopril to avoid increased nephropathy.

Question 2

A primary care NP prescribes fluocinolone cream for a patient who has contact dermatitis. At a follow-up visit in 2 weeks, the patient reports decreased pruritus but continues to have excoriated, erythematous areas. The NP should:

a. obtain a culture of the skin to monitor for superinfection.
b. discontinue the fluocinolone and order betamethasone cream.
c. begin gradually tapering the fluocinolone at 2-week intervals.
d. tell the patient to continue using the fluocinolone for 3 to 4 more weeks.

ciecieme · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

A
Patients with impaired renal function should use low-dose ACE inhibitors. It is not necessary to avoid ACE inhibitors with unilateral renal stenosis.

Answer to Question 2

D
The risk of adverse effects is less if group II steroids are used for less than 6 to 8 weeks. If the condition is responding to treatment, and there are no signs of adverse effects, the NP should recommend continuing use. The patient does not have exudative lesions, so a culture is not necessary.