A nurse is caring for a client who has prescriptions for spironolactone and lisinopril. The nurse should monitor for which of the following adverse effects?

Hypoglycemia

Hyperkalemia

Hyperglycemia

Hypokalemia

Answer and Explanation

The Correct Answer is B

A. Hypoglycemia. Neither spironolactone nor lisinopril directly affects blood glucose levels. Hypoglycemia is more commonly associated with insulin, sulfonylureas (e.g., glipizide), and excessive alcohol consumption, rather than potassium-sparing diuretics or ACE inhibitors.

B. Hyperkalemia. Spironolactone is a potassium-sparing diuretic that promotes sodium excretion while retaining potassium, increasing the risk of hyperkalemia. Lisinopril, an ACE inhibitor, also raises potassium levels by reducing aldosterone secretion, which normally promotes potassium excretion. The combination of these two medications significantly increases the risk of dangerously high potassium levels, which can lead to cardiac arrhythmias, muscle weakness, and life-threatening complications. Clients should have serum potassium levels monitored regularly and be advised to avoid potassium-rich foods and supplements.

C. Hyperglycemia. Neither medication is known to cause hyperglycemia. Thiazide and loop diuretics are more likely to elevate blood glucose levels due to their effects on insulin sensitivity, but spironolactone and lisinopril do not share this effect.

D. Hypokalemia. Spironolactone prevents potassium loss, and lisinopril reduces potassium excretion, making hypokalemia unlikely. Hypokalemia is more commonly seen with loop diuretics (e.g., furosemide) and thiazide diuretics (e.g., hydrochlorothiazide), which promote potassium loss.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Cover the administration area with plastic wrap. After applying nitroglycerin ointment, the area should be covered with plastic wrap or a transparent dressing to prevent evaporation and ensure proper absorption through the skin. This also helps prevent the medication from accidentally transferring to another person or clothing.

B. Massage the ointment into the skin. Nitroglycerin ointment should not be massaged into the skin, as this can cause rapid absorption and lead to hypotension and dizziness due to vasodilation. Instead, it should be applied as a thin, even layer and covered with a dressing.

C. Spread the ointment in a 10 cm² (4 in²) area. The correct application method involves measuring the exact prescribed amount (e.g., using the applicator paper) and applying it in a thin layer. The area of application may vary based on the dosage, but the focus should be on accurate measurement, not a specific area size.

D. Apply the ointment in a thick layer. A thick application is unnecessary and could increase absorption too quickly, leading to side effects such as headache, dizziness, and hypotension. Instead, a measured dose should be spread thinly and evenly onto clean, dry skin.

A. Hemoglobin levels B. Iron levels C. Platelet count D. White blood cell count

Correct Answer is A

Explanation

A. Hemoglobin levels. Epoetin alfa stimulates erythropoiesis (red blood cell production) in clients with chronic renal failure, where natural erythropoietin production is impaired. The therapeutic effect of epoetin alfa is measured by monitoring hemoglobin (Hgb) levels to ensure adequate response without exceeding safe limits. Target Hgb levels should not exceed 11 g/dL, as higher levels increase the risk of thromboembolic events and hypertension.

B. Iron levels. While iron is necessary for red blood cell production, epoetin alfa does not directly affect iron levels. However, iron supplementation may be required if iron deficiency is present, as inadequate iron stores can limit the effectiveness of epoetin alfa therapy.

C. Platelet count. Epoetin alfa primarily affects red blood cell production and has no direct effect on platelet levels. Although polycythemia (excess red blood cells) can increase the risk of clot formation, platelet count is not the primary indicator of epoetin alfa’s therapeutic effects.

D. White blood cell count. Epoetin alfa does not impact white blood cell (WBC) production. Leukocyte production is regulated by different growth factors, and WBC monitoring is more relevant for conditions such as infections, chemotherapy-induced neutropenia, or bone marrow disorders.

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A nurse is caring for a client who has prescriptions for spironolactone and lisinopril. The nurse should monitor for which of the following adverse effects?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who has angina and a new prescription for nitroglycerin ointment. Which of the following actions should the nurse plan to take?

Correct Answer is A

Explanation

A nurse is caring for a client who has chronic renal failure and is receiving epoetin alfa. To check for therapeutic effects, the nurse should monitor which of the following client laboratory tests?

Correct Answer is A

Explanation

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