A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this patient’s plan of care?
Replace salt with a salt substitute.
Limits intake of high-potassium foods.
Cover your skin before going outside.
Monitor skin for excessive bruising.
The Correct Answer is B
Spironolactone is a potassium-sparing diuretic that works by blocking the actions of aldosterone, a hormone that can lead to potassium loss in the urine. However, in some cases, spironolactone can cause hyperkalemia (high levels of potassium in the blood), which can be dangerous for patients with heart failure. Therefore, it is important to instruct the patient to limit their intake of high-potassium foods such as bananas, oranges, tomatoes, spinach, and salt substitutes containing potassium.
Option a (Replace salt with a salt substitute) is incorrect because salt substitutes often contain potassium, which can further increase the risk of hyperkalemia.
Option c (Cover your skin before going outside) is unrelated to the use of spironolactone and hyperkalemia.
Option d (Monitor skin for excessive bruising) is not directly related to the use of spironolactone and hyperkalemia, although it is a potential side effect of other medications used to treat heart failure.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Digoxin is a medication commonly used to treat heart failure by strengthening the heart's contractions and slowing down the heart rate. However, it can also cause nausea, vomiting, and loss of appetite, especially when levels in the body are too high. Furosemide is a diuretic medication that helps to remove excess fluid from the body, which is often necessary in heart failure. However, it can also cause electrolyte imbalances, such as low potassium levels, which can contribute to nausea and vomiting.
Therefore, in a client with heart failure who is experiencing these symptoms, it is important to assess their medication regimen, including dosages and serum levels, to ensure that they are not experiencing medication side effects or toxicity.
Adjustments may need to be made to the client's medication regimen to manage symptoms effectively and prevent further complications. Options (a), (b), and (d) do not have as direct a correlation to the current symptoms and would not have the same level of significance when planning care for this client.

Correct Answer is B
Explanation
Orlistat works by inhibiting the absorption of dietary fat in the intestines. The side effects of faty stools and flatus can be managed by reducing the intake of dietary fat. The nurse should ask the client to describe her dietary intake history for the last several days to determine if she has been consuming a diet high in fat.
Based on this information, the nurse can provide appropriate dietary advice to help manage these side effects.
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