A nurse is educating a patient newly prescribed spironolactone for hypertension.
Which patient statement indicates the need for further teaching regarding safe medication use?
I will take this medication with food to increase absorption and reduce stomach upset.
I will decrease the dose myself if I feel well after two weeks.
I should monitor my heart rhythm and report any irregularities to my healthcare provider.
I will avoid using salt substitutes and potassium-rich foods while taking this medication.
The Correct Answer is B
This question tests patient understanding of potassium-sparing diuretics. It requires identifying the need for further education when a patient plans to alter their medication dosage independently, which poses a severe risk of life-threatening electrolyte imbalances, particularly hyperkalemia, in patients prescribed this diuretic therapy.
Choice A rationale
Taking spironolactone with food is recommended as it helps to increase the drug's oral bioavailability and significantly reduces the common gastrointestinal side effects, such as nausea or stomach upset, which are frequently reported by patients during the initial weeks of treatment.
Choice B rationale
Patients must never independently alter their medication dose. Spironolactone acts as an aldosterone antagonist, and self-adjusting the dose can lead to erratic blood pressure control or severe, potentially life-threatening hyperkalemia, which is a significant clinical risk requiring ongoing provider monitoring.
Choice C rationale
Spironolactone can cause hyperkalemia, which significantly increases the risk of cardiac dysrhythmias. Patients are rightly taught to monitor for signs of irregular heartbeats, such as palpitations or skipped beats, and report these concerns immediately to ensure proper cardiovascular safety and monitoring.
Choice D rationale
Salt substitutes often contain potassium chloride, and potassium-rich foods can contribute to dangerous elevations in serum potassium levels. Patients on spironolactone are at a high risk for hyperkalemia (normal range 3.5 to 5.0 mEq/L) and must avoid these dietary sources.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This question assesses understanding of the feedback loop in thyroid function. It requires applying knowledge of the hypothalamus-pituitary-thyroid axis, specifically how exogenous levothyroxine affects pituitary secretion of TSH, which is the primary indicator of thyroid replacement therapy effectiveness in hypothyroid patients.
Choice A rationale
Levothyroxine is a synthetic form of thyroxine (T4). If the medication is effective, T4 levels should increase or normalize to the standard range of 5.0 to 12.0 mcg/dL, rather than decrease, indicating that the patient has successfully corrected their hormone deficiency.
Choice B rationale
Increased sleep is not a specific indicator of a therapeutic response to levothyroxine. In fact, patients who are over-replaced may experience insomnia. Hypothyroid patients often report excessive lethargy, so normalization of energy levels, rather than increased sleep, is the desired outcome.
Choice C rationale
In a healthy feedback loop, TSH, with a normal range of 0.4 to 4.0 mIU/L, is suppressed by circulating T4. A decrease in TSH levels indicates that the exogenously administered levothyroxine is successfully restoring thyroid function to the patient's normal physiological range.
Choice D rationale
Weight gain is a classic symptom of hypothyroidism due to a slowed basal metabolic rate. A therapeutic response to levothyroxine should lead to weight normalization or loss as the patient's metabolism returns to its normal state, making an increase in weight undesirable.
Correct Answer is B
Explanation
This question tests the classification of insulins based on their pharmacokinetic profiles. It requires identifying the specific long-acting insulin analog that provides a relatively constant basal glycemic control without a pronounced peak for 24 hours, which is vital for safe diabetes management.
Choice A rationale
Insulin detemir is a long-acting insulin analog that has a variable duration of action, typically ranging from 12 to 24 hours depending on the administered dose. It does not provide a consistent, peakless 24-hour duration for all patients.
Choice B rationale
Insulin glargine is a long-acting insulin analog designed to provide a steady, peakless, basal insulin level for 24 hours. Its chemical structure allows for slow precipitation in subcutaneous tissue, ensuring continuous, consistent release throughout the full day for diabetic control.
Choice C rationale
Humulin R is a regular, short-acting insulin. It has a rapid onset and a relatively short duration of action, typically lasting 5 to 8 hours. It is used to cover meals or for glycemic correction, not as a long-acting basal insulin.
Choice D rationale
Lispro is a rapid-acting insulin analog with an onset within 15 minutes and a duration of only 3 to 4 hours. It is designed specifically to cover mealtime glucose spikes and is never used as a long-acting basal insulin therapy.
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