A nurse preparing to administer morning medications notes that a ...

[melly21297]

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten) concurrently with spironolactone (Aldactone).
 
  Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 5.1 mEq/L, and a blood glucose level of 128 mg/dL. Which intervention is appropriate?
  a. Administer the medications as ordered.
  b. Ask the patient about the use of salt substitutes.
  c. Contact the provider to report the laboratory values.
  d. Request an order for furosemide (Lasix).

Question 2

A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question?
 
  a. Bumetanide (Bumex)
  b. Furosemide (Lasix)
  c. Spironolactone (Aldactone)
  d. Hydrochlorothiazide (HydroDIURIL)

[ebonylittles]

Answer to Question 1

ANS: C
Spironolactone should not be administered with ACE inhibitors, which can also elevate potassium levels. Because the potassium level is elevated, the nurse should not administer the medication and should obtain clarification of the order. There is no need to repeat the potassium level test that was just done this morning. Requesting an order for furosemide is appropriate only after the provider has been notified of the laboratory values.

Answer to Question 2

ANS: C
Spironolactone is a nonpotassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.

[melly21297]

TYSM

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