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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Correct Answer is B

Explanation

A. "I can discontinue this medication after one negative sputum culture." Treatment for tuberculosis requires a long-term regimen lasting at least 6 months, even if the sputum culture becomes negative. Discontinuing rifampin too early increases the risk of drug resistance and treatment failure. The client must continue therapy as prescribed and complete the full course.

B. "I should take this medication on an empty stomach." Rifampin should be taken on an empty stomach (1 hour before or 2 hours after meals) to improve absorption and effectiveness. Food can reduce the bioavailability of the drug, making it less effective in treating tuberculosis. If gastrointestinal discomfort occurs, the client should consult their provider before making adjustments.

C. "I should expect to have ringing in my ears." Tinnitus (ringing in the ears) is not a common side effect of rifampin. Ototoxicity is more commonly associated with aminoglycosides (e.g., streptomycin) or vancomycin. Rifampin’s notable side effects include hepatotoxicity, red-orange discoloration of body fluids, and gastrointestinal disturbances.

D. "I can expect to have joint pain." While rifampin can cause mild flu-like symptoms, including fatigue and muscle aches, persistent joint pain is not a typical side effect. If joint pain occurs, it may be related to another condition, such as drug-induced hepatotoxicity or an adverse reaction to other tuberculosis medications (e.g., pyrazinamide, which can cause gout-like symptoms).

A. Excoriation B. Firmness C. Ulceration D. Bleeding

Correct Answer is B

Explanation

A. Excoriation. Excoriation (skin abrasion or scratching) does not indicate a positive tuberculin skin test. A positive reaction is determined by induration (firm swelling) rather than skin irritation or superficial damage. Scratching the site can cause redness, but this is not a diagnostic sign of tuberculosis exposure.

B. Firmness. A positive tuberculin skin test is identified by the presence of induration (firm, raised swelling) at the injection site, which is measured in millimeters. The size of induration considered positive depends on the client’s risk factors. For example, ≥5 mm is positive in immunocompromised individuals, ≥10 mm in high-risk populations, and ≥15 mm in individuals with no risk factors.

C. Ulceration. Ulceration is not a typical reaction to a tuberculin skin test. If ulceration occurs, it may indicate improper injection technique, irritation, or an allergic reaction, rather than a true positive result. The test should be repeated in such cases.

D. Bleeding. Minor pinpoint bleeding at the injection site may occur due to the needle puncture but does not indicate a positive result. The key indicator of a positive test is the presence of measurable induration, not redness, bruising, or bleeding.

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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

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Explanation

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