A patient is taking spironolactone and comes to the clinic ...

[karlynnae]

A patient is taking spironolactone and comes to the clinic complaining of weakness and tingling of the hands and feet. The primary care NP notes a heart rate of 62 beats per minute and a blood pressure of 100/58 mm Hg. The NP should:
 
  a. obtain a serum drug level.
  b. order an electrocardiogram (ECG) and serum electrolytes.
  c. change the medication to a thiazide diuretic.
  d. question the patient about potassium intake.

Question 2

An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won't have to deal with pills or periods. The primary care NP should tell her that she:
 
  a. should consider another form of contraception after 1 year.
  b. may have irregular bleeding, especially in the first month or so.
  c. will need to take calcium and vitamin D every day while using this method.
  d. will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics.

[bulacsom]

Answer to Question 1

B
The patient is showing signs of hyperkalemia, so the NP should order an ECG and serum electrolytes. This should be done before changing the medication. Because hyperkalemia can cause fatal arrhythmias, an ECG is necessary.

Answer to Question 2

B
Because of strong progestational effects on the endometrium, irregular bleeding or spotting is common in the early months of use. Because of concerns about the effect of depot medroxyprogesterone acetate on bone density, it is recommended that woman change to another birth control method after 2 years, not 1 year. Calcium and vitamin D supplements have not been shown to prevent bone density loss. It is not necessary to take oral contraceptive pills when taking antibiotics.

[karlynnae]

Excellent

[at]

TYSM