A nurse is checking the forearm of a client who received a tuberculin skin test 48 hr ago. Which of the following findings at the injection site should indicate to the nurse a positive result?

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.

A. Add the medications to the enteral feeding bag. Medications should not be mixed with enteral feeding formula as this can alter drug absorption, cause tube clogging, or result in medication interactions. Each medication should be administered separately to ensure proper effectiveness.

B. Check for gastric residual 15 min after administering the medications. Gastric residual volume (GRV) should be checked before medication administration to assess delayed gastric emptying. Checking it after administration is unnecessary and may disrupt medication absorption without clinical benefit.

C. Keep the client's head elevated 15° while administering the medications. The head of the bed should be elevated at least 30–45 degrees, not 15 degrees, to reduce aspiration risk and promote medication passage. Insufficient elevation increases the likelihood of regurgitation and aspiration pneumonia.

D. Flush the tube with 30 ml of water between each medication. Flushing with 30 mL of water between medications prevents tube clogging and ensures each drug is properly delivered. It also minimizes drug interactions by preventing medications from mixing within the tube.