A patient receiving spironolactone to treat hypertension. Which of the following instructions should a nurse… - SCTIMST Staff Nurse - 2015 (Set-B)

SCTIMST Staff Nurse - 2015 (Set-B)

Pharmacology

Medium

Appeared in: SCTIMST Staff Nurse - 2015 (Set-B)

Explanation

Spironolactone is classified as a potassium-sparing diuretic, which means it works by blocking aldosterone, leading to the excretion of sodium and water but the retention of potassium.
This potassium retention places the patient at a high risk for developing hyperkalemia (serum potassium level greater than 5.0 mEq/L).
Many commercially available salt substitutes contain potassium chloride instead of sodium chloride.
Instructing the patient to avoid salt substitutes is a crucial safety measure to prevent adding excess potassium to the body, which could lead to dangerously high levels.

Option A: This instruction is dangerous as it would increase dietary potassium intake, exacerbating the risk of hyperkalemia caused by spironolactone.
Option B: Taking a potassium supplement along with a potassium-sparing diuretic is contraindicated and significantly increases the risk of life-threatening hyperkalemia.
Option C: Spironolactone is prescribed for hypertension, and sodium restriction is a cornerstone of non-pharmacological management. Discontinuing it would counteract the drug's therapeutic effect and worsen blood pressure control.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient education for a client taking a potassium-sparing diuretic (spironolactone) to guide bedside assessment, documentation, and the next nursing action.
Patient education is a critical nursing responsibility to prevent adverse drug events. For potassium-sparing diuretics, preventing hyperkalemia is a top patient-safety priority.
Nurses must monitor serum potassium levels and assess for signs of hyperkalemia, such as muscle weakness, fatigue, paresthesias, and ECG changes (peaked T waves).
What if? If the patient were taking furosemide (a loop diuretic) instead, the correct instruction would be to increase intake of potassium-rich foods, as furosemide is potassium-wasting.

How to Approach the Question

Identify the drug in the question: spironolactone.
Recall the pharmacological class of spironolactone. It is a potassium-sparing diuretic.
Understand the primary electrolyte imbalance associated with this class: retention of potassium, leading to a risk of hyperkalemia.
Evaluate each option based on this risk. Any option that increases the body's potassium level will be incorrect and potentially harmful.
Options A (high-K foods) and B (K supplements) directly increase potassium. Option D (salt substitutes) are often made of potassium chloride, also increasing potassium. Therefore, the correct safety instruction is to avoid these.
Option C (discontinuing sodium restriction) is incorrect because the drug is for hypertension, which requires sodium control.

Concept Tested & Keywords

Concept Tested: Patient education for a client taking a potassium-sparing diuretic (spironolactone).
Stem keywords: spironolactone, hypertension, nurse, instructions
Lead-in keywords: Which of the following
Clinical cues: Drug: spironolactone (indicates a potassium-sparing diuretic)

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 156-158

E6 Nursing Fundamentals Taylor p. 786-788