A nurse is assessing a female client.
Click to highlight the client's findings that are a potential contraindication to the client's new prescription and the nurse should report to the provider. To deselect a finding, click on the finding again.
Nurses' Notes:
Today, 0830:
Client presents to the clinic for the management of hypertension and review of laboratory tests obtained 3 days before this visit. Client has a history of hypertension and asthma. Client is currently taking lisinopril 5 mg PO daily.
Today, 0845:
Client is alert and oriented to person, place, time, and situation. Respirations are even and non-labored. Scattered wheezes auscultated in bilateral anterior lung fields. Vital signs were obtained.
Vital Signs:
Today, 0845:
Temperature: 37.1° C (98.8° F)
Heart rate: 90/min
Respiratory rate: 20/min
Blood pressure: 158/78 mm Hg
Oxygen saturation: 95%
Laboratory Results
3 days ago:
Hemoglobin: 11 g/dL (12 to 16 g/dL)
Hematocrit: 40% (37% to 47%)
Sodium: 138 mEq/L (136 to 145 mEq/L)
Potassium: 5.6 mEq/L (3.5 to 5 mEq/L)
BUN: 30 mg/dL (10 to 20 mg/dL)
Creatinine: 2 mg/dL (0.5 to 1 mg/dL)
Client has a history of hypertension and asthma
Client is currently taking lisinopril 5 mg PO daily
Scattered wheezes auscultated in bilateral anterior lung fields
Temperature: 37.1° C (98.8° F)
Heart rate: 90/min
Respiratory rate: 20/min
Blood pressure: 158/78 mm Hg
Oxygen saturation: 95%
Creatinine: 2 mg/dL (0.5 to 1 mg/dL)
Hematocrit: 40% (37% to 47%)
BUN: 30 mg/dL (10 to 20 mg/dL)
Potassium: 5.6 mEq/L (3.5 to 5 mEq/L)
The Correct Answer is ["B","H","K","L"]
Spironolactone is a potassium-sparing diuretic that functions as an aldosterone antagonist in the distal convoluted tubule and collecting duct. It promotes the excretion of sodium and water while retaining potassium, making it effective for hypertension but dangerous in the presence of renal insufficiency. Significant contraindications include pre-existing hyperkalemia or concurrent use of other medications that inhibit the renin-angiotensin-aldosterone system, as these combinations exponentially increase the risk of lethal cardiac dysrhythmias.
Rationale:
A. The client is currently taking lisinopril, an ACE inhibitor, which also increases serum potassium by suppressing aldosterone secretion. Combining lisinopril with spironolactone creates a synergistic effect that leads to severe hyperkalemia. This drug-drug interaction is a major clinical concern because both agents reduce the kidneys' ability to excrete potassium. The nurse must report this concurrent therapy to prevent potential cardiac toxicity resulting from excessive potassium accumulation.
B. The client's potassium level of 5.6 mEq/L already indicates hyperkalemia, as it exceeds the normal physiological limit of 5.0 mEq/L. Administering spironolactone to a client with an already elevated potassium concentration is strictly contraindicated. Increasing the potassium burden through potassium-sparing effects could lead to peaked T waves, conduction blocks, or asystole. This laboratory finding must be addressed and corrected before any further potassium-retaining medications are administered.
C. A BUN (blood urea nitrogen) of 30 mg/dL signifies impaired renal clearance and decreased glomerular filtration. Elevated nitrogenous waste products often indicate that the kidneys are unable to maintain proper electrolyte balance. Since spironolactone relies on renal excretion and affects renal tubular transport, its use in a client with azotemia is highly risky. This finding suggests the client is at an increased risk for metabolic imbalances if the diuretic is initiated.
D. A creatinine level of 2 mg/dL is double the upper limit of the normal range, indicating significant renal dysfunction. Spironolactone is generally contraindicated or requires extreme caution in patients with a creatinine clearance that is significantly reduced. Impaired renal function prevents the body from managing the potassium-sparing effects of the drug, leading to a rapid and dangerous rise in serum electrolytes. This objective marker of kidney failure makes the new prescription inappropriate for the client's current clinical status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Methylergonovine is an ergot alkaloidused to manage postpartum hemorrhage by inducing firm, sustained uterine contractions. It acts directly on the uterine smooth muscle but also possesses significant vasoconstrictive properties. Because it can cause a rapid and dangerous rise in systemic vascular resistance, it is strictly contraindicated in patients with hypertensive disorders.
Rationale:
A.Lochia rubra is the normal, bloody vaginal discharge observed in the immediate postpartum period and is not a contraindication for methylergonovine. In fact, if the lochia is excessive due to uterine atony (a boggy fundus), methylergonovine is indicated to stop the bleeding. The medication helps transition the uterus to a firm state, which actually reduces the volume of lochia rubra.
B.A blood pressure of 190/110 mm Hg is a critical contraindication because methylergonovine causes systemic arterial vasoconstriction. Administering this medication to a hypertensive patient could lead to a stroke, myocardial infarction, or seizure. The nurse must withhold the dose and notify the provider, as this drug can exacerbate pre-eclampsia or chronic hypertension to life-threatening levels.
C.A distended bladder can cause the uterus to become boggy by displacing it upward and to the side, but it does not contraindicate methylergonovine. While the nurse should encourage the patient to void to allow for natural uterine contraction, the presence of a full bladder does not make the drug unsafe. Clinical priority involves emptying the bladder to accurately assess fundal tone.
D.A urinary output of 60 mL/hr is a normal physiological finding and indicates adequate renal perfusion in the postpartum patient. There is no pharmacological reason to withhold methylergonovine based on this healthy urine volume. The nurse should continue to monitor output, but 60 mL/hr suggests the patient is hemodynamically stable and capable of clearing medications through the kidneys.
Correct Answer is B
Explanation
Simvastatin is an HMG-CoA reductase inhibitorused to treat dyslipidemia by reducing hepatic cholesterol synthesis. While effective for cardiovascular prophylaxis, it carries risks of hepatotoxicityand myopathy. Clinical monitoring focuses on liver function tests and markers of muscle integrity to detect early signs of statin-inducedorgan injury.
Rationale:
A.Decreased creatine kinase (CK) is not a finding of clinical concern; however, increased CK would be highly significant. Elevated CK levels indicate muscle breakdown or rhabdomyolysis, which is a rare but severe side effect of statin therapy. A low or normal CK level suggests that the medication is not currently causing significant damage to the client's skeletal muscle tissue.
B.Increased alkaline phosphatase is a marker of potential liver injury or biliary obstruction and must be reported to the provider immediately. Since simvastatin is processed by the liver, it can cause asymptomatic elevations in liver enzymes or, in rare cases, drug-induced hepatitis. The nurse must monitor for jaundice and upper quadrant pain when these laboratory values are elevated.
C.Increased HDL is a positive therapeutic outcome of simvastatin therapy and does not need to be reported as an adverse finding. High-density lipoprotein is the "good" cholesterol that aids in the transport of cholesterol away from the arteries. An increase in this value indicates that the medication and lifestyle changes are successfully reducing the client's overall cardiovascular risk profile.
D.Decreased HbA1c is generally a favorable finding, as it indicates improved long-term glucose control. Statins have actually been associated with a slight increase in HbA1c and blood glucose levels in some patients, potentially increasing the risk of diabetes. Therefore, a decrease would not be considered a medication-related adverse effect that requires urgent notification to the healthcare provider.
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