A nurse is preparing to administer medication to a client.
Which of the following identifiers should the nurse use to identify the client?

Choice A rationale

Spironolactone is a potassium-sparing diuretic. Its mechanism of action involves blocking aldosterone receptors in the kidney's distal convoluted tubule and collecting duct, leading to increased sodium and water excretion while retaining potassium. Consequently, taking a potassium supplement concurrently would dangerously increase the risk of hyperkalemia, a condition characterized by high blood potassium levels (normal range is 3.5-5.0 mEq/L), which can cause life-threatening cardiac dysrhythmias.

Choice B rationale

Spironolactone's primary effect is on sodium and potassium balance, not calcium. Calcium supplements do not typically interact with spironolactone in a way that would cause a significant, adverse change in calcium levels. The nurse should instruct the client to avoid supplements that directly alter the electrolytes affected by the medication's mechanism of action.

Choice C rationale

Spironolactone does not significantly impact iron metabolism. Therefore, a client taking an iron supplement would not be at increased risk of an adverse interaction. Iron supplements are generally well-tolerated with spironolactone, and there is no contraindication for their concurrent use. The focus of client teaching should be on electrolytes directly affected by the medication.

Choice D rationale

Spironolactone does not have a direct or clinically significant interaction with magnesium supplements. While diuretics can sometimes affect magnesium levels, spironolactone's primary action is on potassium and sodium. Therefore, there is no major contraindication for the use of magnesium supplements, unlike the life-threatening risk associated with potassium supplementation. *.

Choice A rationale

Measuring the client's legs with a tape measure is the correct action to ensure proper sizing of the antiembolic stockings. Correct sizing is critical for effective venous compression and to prevent complications such as skin irritation, tissue damage, or impaired circulation. Stockings that are too tight can act as a tourniquet, while those that are too loose will not provide the necessary graduated compression to facilitate venous return and prevent blood stasis, which is the underlying cause of deep-vein thrombosis. This precise measurement ensures the stockings fit snugly and provide optimal therapeutic benefit.

Choice B rationale

Removing the stockings every 24 hours is an insufficient interval for skin integrity checks and to allow for proper cleaning and assessment. The standard practice involves removing antiembolic stockings at least twice daily for a short period. This allows the nurse to inspect the client's skin for any signs of pressure, irritation, or breakdown, and to perform hygiene. Prolonged, continuous wear without breaks can compromise skin integrity and increase the risk of developing pressure injuries, especially in a client who is less mobile due to their condition.

Choice C rationale

Folding the stockings at the top is a harmful and dangerous practice. Folding creates a constrictive band around the client's leg, which acts as a tourniquet. This constriction impedes venous and lymphatic return, leading to increased risk of blood stasis, edema, and tissue damage. The pressure from the folded band can severely compromise circulation and potentially worsen the client's underlying deep-vein thrombosis. The stockings should be smooth and wrinkle-free to provide uniform graduated compression.

Choice D rationale

Massaging the legs of a client with deep-vein thrombosis (DVT) is contraindicated and can be extremely dangerous. Massaging can dislodge the thrombus (blood clot) from the venous wall. If the clot becomes dislodged, it can travel through the bloodstream, leading to a pulmonary embolism (PE), a life-threatening condition where the clot obstructs a pulmonary artery in the lungs. Therefore, any form of massage or direct pressure on the affected limb is strictly avoided to prevent this potentially fatal complication. *.