Report serum potassium above 5.0 mEq/L and signs of hyperkalemia: muscle weakness, paresthesias, or irregular pulse.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A client taking spironolactone reports tender, enlarged breast tissue. What is the nurse's best response?
Answer: A. Spironolactone has anti-androgenic effects and can cause gynecomastia, breast tenderness, and menstrual irregularities. The nurse should acknowledge this is a known side effect and advise the client to discuss it with the provider, who may switch medications. It is not a sign of cancer, infection, or fluid overload.
Question 2 of 4
A client with heart failure and reduced ejection fraction is prescribed spironolactone. Which laboratory value is MOST important for the nurse to monitor?
Answer: A. Spironolactone is a potassium-sparing aldosterone antagonist that can cause hyperkalemia, so serum potassium must be monitored closely, especially when combined with ACE inhibitors. While renal function is also followed, the key drug-specific safety concern with spironolactone is an elevated potassium level that can cause life-threatening dysrhythmias.
Question 3 of 4
The nurse is administering spironolactone to a client with heart failure. Which finding should the nurse report to the provider before giving the dose?
Answer: A. Spironolactone is a potassium-sparing diuretic, so hyperkalemia is the major risk. A serum potassium of 5.8 mEq/L is above the normal range (3.5 to 5.0 mEq/L) and could lead to dangerous dysrhythmias; the nurse should hold the dose and notify the provider. The other findings are within normal limits or expected.
Question 4 of 4
A client takes spironolactone daily. Which instruction is most important for the nurse to provide?
Answer: B. Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia. Clients should avoid potassium-based salt substitutes and high-potassium intake to prevent dangerous elevations.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Blocks aldosterone, causing loss of sodium and water but retention of potassium (potassium-sparing).
- Hyperkalemia is the major risk, increased by potassium supplements, salt substitutes, ACE inhibitors, and ARBs.
- Improves survival in chronic heart failure with reduced ejection fraction.
- Endocrine effects include gynecomastia, breast tenderness, and menstrual irregularities.
- Onset of diuretic effect is gradual (days) compared with loop diuretics.
- Best taken in the morning to avoid nighttime urination.
Nursing priorities
- Monitor serum potassium and renal function regularly and report hyperkalemia.
- Teach the patient to avoid potassium supplements and potassium-based salt substitutes.
- Assess fluid status: daily weights, intake and output, edema, and blood pressure.
- Administer in the morning and assess for endocrine side effects.
Labs & values
Patient teaching
- Avoid salt substitutes and potassium supplements unless your provider approves them.
- Report muscle weakness, numbness, tingling, or an irregular heartbeat.
- Take the medication in the morning to limit nighttime urination.
- Weigh yourself daily and report a gain of 2-3 pounds in a day or 5 pounds in a week.
- Report breast tenderness or enlargement, which can occur and may be reversible.
Red flags: report now
- Report serum potassium above 5.0 mEq/L and signs of hyperkalemia: muscle weakness, paresthesias, or irregular pulse.
- Report peaked T waves or other ECG changes consistent with hyperkalemia.
- Combining with ACE inhibitors or ARBs without monitoring can cause dangerous hyperkalemia.
References
Clinical references for this topic
