The nurse teaches a client with nephrotic syndrome about the condition and course of treatment. Which statement by the client indicates a need for further instruction?

Rationale: A. This statement is incorrect and clearly indicates a need for further instruction. In nephrotic syndrome, the primary problem is increased permeability of the glomerular membrane, which leads to significant protein loss in the urine (proteinuria). This results in low levels of protein in the blood (hypoalbuminemia). Lisinopril, an ACE inhibitor, is actually prescribed to reduce proteinuria by decreasing intraglomerular pressure. It helps protect kidney function and slows disease progression. The client’s belief that lisinopril worsens low blood protein is a misunderstanding of the medication’s purpose. Discontinuing this medication could lead to worsening kidney damage and increased protein loss. This misconception must be corrected. B. This statement is correct and reflects understanding of the disease process. The loss of albumin in nephrotic syndrome decreases plasma oncotic pressure, causing fluid to shift from the vascular space into the interstitial tissues. This leads to edema, commonly seen in the hands, feet, face (periorbital edema), and abdomen (ascites). Recognizing this expected symptom indicates the client understands a key manifestation of the condition. C. This statement is also correct. Management of nephrotic syndrome often includes diuretics to reduce fluid overload and edema, as well as lipid-lowering medications such as statins because hyperlipidemia is a common complication. The liver increases lipid production in response to low oncotic pressure, leading to elevated cholesterol and triglycerides. Understanding the need for these medications shows appropriate comprehension of treatment goals. D. This statement is accurate and demonstrates good understanding of the condition. Nephrotic syndrome is classically characterized by hypoalbuminemia (low protein in the blood due to urinary losses) and hyperlipidemia (elevated cholesterol levels). These are hallmark features of the disease. The client correctly identifies both abnormalities, indicating proper understanding and no need for further teaching for this point.