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 C

Explanation

A. Glucosamine. Glucosamine is a supplement used to support joint health, particularly in osteoarthritis. It does not have significant interactions with digoxin and is not known to affect cardiac function or digoxin metabolism, making it safe to use concurrently.

B. Garlic. Garlic has blood-thinning properties and may mildly lower blood pressure, but it does not directly interfere with digoxin metabolism. However, clients on anticoagulants or blood pressure medications should use garlic cautiously due to its potential to enhance their effects.

C. St. John's wort. St. John’s wort induces liver enzymes that can increase the metabolism of many medications, including digoxin. This can lead to decreased digoxin levels, reducing its effectiveness and increasing the risk of uncontrolled heart failure or atrial fibrillation. Clients taking digoxin should avoid St. John’s wort to maintain therapeutic drug levels.

D. Ginkgo biloba. Ginkgo biloba is primarily used to enhance cognitive function and circulation. While it has mild blood-thinning effects, it does not significantly impact digoxin metabolism. However, caution is advised in clients taking anticoagulants or antiplatelet medications to avoid an increased risk of bleeding.

A. Promethazine B. Amlodipine C. Fluconazole D. Phenazopyridine

Correct Answer is B

Explanation

A. Promethazine. Promethazine is an antihistamine used to treat nausea, vomiting, and allergic reactions. It does not have antihypertensive properties and does not lower blood pressure. Instead, it has sedative effects and is commonly used for motion sickness or as a preoperative medication.

B. Amlodipine. Amlodipine is a calcium channel blocker that lowers blood pressure by relaxing blood vessels and improving blood flow. It is commonly prescribed for hypertension and angina, as it reduces vascular resistance and decreases the workload on the heart. Clients taking amlodipine should be monitored for hypotension, edema, and dizziness.

C. Fluconazole. Fluconazole is an antifungal medication used to treat fungal infections such as candidiasis. It does not affect blood pressure regulation and is not used for managing hypertension. However, it can interact with certain medications, so monitoring for drug interactions is important.

D. Phenazopyridine. Phenazopyridine is a urinary analgesic used to relieve symptoms of urinary tract infections (UTIs), such as burning and pain during urination. It does not lower blood pressure and has no effect on cardiovascular function. Clients should be advised that this medication can cause orange discoloration of the urine.

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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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