A nurse is assessing a female client.
Click to highlight the client's findings that are a potential contraindication to the client's new prescription and the nurse should report to the provider. To deselect a finding, click on the finding again.
Nurses' Notes:
Today, 0830:
Client presents to the clinic for the management of hypertension and review of laboratory tests obtained 3 days before this visit. Client has a history of hypertension and asthma. Client is currently taking lisinopril 5 mg PO daily.
Today, 0845:
Client is alert and oriented to person, place, time, and situation. Respirations are even and non-labored. Scattered wheezes auscultated in bilateral anterior lung fields. Vital signs were obtained.
Vital Signs:
Today, 0845:
Temperature: 37.1° C (98.8° F)
Heart rate: 90/min
Respiratory rate: 20/min
Blood pressure: 158/78 mm Hg
Oxygen saturation: 95%
Laboratory Results
3 days ago:
Hemoglobin: 11 g/dL (12 to 16 g/dL)
Hematocrit: 40% (37% to 47%)
Sodium: 138 mEq/L (136 to 145 mEq/L)
Potassium: 5.6 mEq/L (3.5 to 5 mEq/L)
BUN: 30 mg/dL (10 to 20 mg/dL)
Creatinine: 2 mg/dL (0.5 to 1 mg/dL)
Client has a history of hypertension and asthma
Client is currently taking lisinopril 5 mg PO daily
Scattered wheezes auscultated in bilateral anterior lung fields
Temperature: 37.1° C (98.8° F)
Heart rate: 90/min
Respiratory rate: 20/min
Blood pressure: 158/78 mm Hg
Oxygen saturation: 95%
Creatinine: 2 mg/dL (0.5 to 1 mg/dL)
Hematocrit: 40% (37% to 47%)
BUN: 30 mg/dL (10 to 20 mg/dL)
Potassium: 5.6 mEq/L (3.5 to 5 mEq/L)
The Correct Answer is ["B","H"]
Spironolactone is a potassium-sparing diuretic that functions as an aldosterone antagonist in the distal convoluted tubule and collecting duct. It promotes the excretion of sodium and water while retaining potassium, making it effective for hypertension but dangerous in the presence of renal insufficiency. Significant contraindications include pre-existing hyperkalemia or concurrent use of other medications that inhibit the renin-angiotensin-aldosterone system, as these combinations exponentially increase the risk of lethal cardiac dysrhythmias.
Rationale:
A. The client is currently taking lisinopril, an ACE inhibitor, which also increases serum potassium by suppressing aldosterone secretion. Combining lisinopril with spironolactone creates a synergistic effect that leads to severe hyperkalemia. This drug-drug interaction is a major clinical concern because both agents reduce the kidneys' ability to excrete potassium. The nurse must report this concurrent therapy to prevent potential cardiac toxicity resulting from excessive potassium accumulation.
B. The client's potassium level of 5.6 mEq/L already indicates hyperkalemia, as it exceeds the normal physiological limit of 5.0 mEq/L. Administering spironolactone to a client with an already elevated potassium concentration is strictly contraindicated. Increasing the potassium burden through potassium-sparing effects could lead to peaked T waves, conduction blocks, or asystole. This laboratory finding must be addressed and corrected before any further potassium-retaining medications are administered.
C. A BUN (blood urea nitrogen) of 30 mg/dL signifies impaired renal clearance and decreased glomerular filtration. Elevated nitrogenous waste products often indicate that the kidneys are unable to maintain proper electrolyte balance. Since spironolactone relies on renal excretion and affects renal tubular transport, its use in a client with azotemia is highly risky. This finding suggests the client is at an increased risk for metabolic imbalances if the diuretic is initiated.
D. A creatinine level of 2 mg/dL is double the upper limit of the normal range, indicating significant renal dysfunction. Spironolactone is generally contraindicated or requires extreme caution in patients with a creatinine clearance that is significantly reduced. Impaired renal function prevents the body from managing the potassium-sparing effects of the drug, leading to a rapid and dangerous rise in serum electrolytes. This objective marker of kidney failure makes the new prescription inappropriate for the client's current clinical status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Levodopa is a dopamine precursorthat crosses the blood-brain barrier to treat Parkinson's disease by replenishing depleted striatal dopamine. When combined with non-selective monoamine oxidase inhibitors(MAOIs), it can trigger a massive release of catecholamines, leading to a dangerous hypertensive crisis. This sympathomimetic surgeresults from the simultaneous increase in dopamine synthesis and the inhibition of its metabolic breakdown.
Rationale:
A.Phenelzine is a non-selective MAOI that, when taken with levodopa, can lead to a life-threatening hypertensive crisis. This occurs because levodopa increases dopamine levels while phenelzine prevents the enzymatic breakdown of monoamines, resulting in excessive systemic vasoconstriction. The nurse must ensure a washout period of at least 14 days between these two specific pharmacological agents.
B.Ibuprofen is a non-steroidal anti-inflammatory drug that does not typically have a life-threatening interaction with levodopa. While all medications should be monitored for general side effects, ibuprofen does not interfere with the dopaminergic pathways or metabolic breakdown of levodopa. It is generally considered safe for managing mild musculoskeletal pain in patients with Parkinson's disease.
C.Diphenhydramine is an antihistamine with anticholinergic properties that is sometimes used as an adjunct in Parkinson's therapy to reduce tremors. It does not cause a life-threatening complication when paired with levodopa; in fact, it may provide synergistic benefits for motor symptoms. However, the nurse should monitor the patient for increased sedation and urinary retention.
D.Vitamin B12 is a water-soluble vitamin essential for neurological health and does not interact dangerously with levodopa. It is often pyridoxine (Vitamin B6) that is of concern, as B6 can increase the peripheral conversion of levodopa, reducing its efficacy. Vitamin B12 supplementation is generally safe and does not pose a risk for hypertensive or catecholamine-related emergencies.
Correct Answer is B
Explanation
Ototoxicityis a serious adverse effect of certain drug classes that results in damage to the cochlea or vestibular apparatus. Aminoglycosidesare well-known for this risk, potentially causing permanent sensorineural hearing loss or equilibrium disturbances. Monitoring drug trough levelsis a critical nursing intervention to minimize the accumulation of these drugs in the inner ear.
Rationale:
A.Rifampin is an antitubercular agent primarily known for hepatotoxicity and causing a harmless orange discoloration of body fluids. It is not associated with eighth cranial nerve damage or hearing loss. While it has many drug interactions, the nurse would prioritize monitoring liver function tests rather than auditory acuity for a client receiving this specific antibiotic medication.
B.Gentamicin is an aminoglycoside antibiotic that is highly ototoxic and nephrotoxic. It can cause irreversible damage to the hair cells in the organ of Corti, leading to progressive hearing loss or tinnitus. The nurse must monitor the client for any changes in hearing or balance and ensure that serum peak and trough levels remain within the safe therapeutic range.
C.Ciprofloxacin is a fluoroquinolone antibiotic that carries a boxed warning for tendon rupture and peripheral neuropathy, but it is not typically ototoxic. While it can cause central nervous system effects like dizziness, it does not target the auditory system. The nurse should focus on teaching the client about photosensitivity and avoiding minerals that interfere with the drug's absorption.
D.Penicillin G is a beta-lactam antibiotic with a wide safety margin, primarily carrying risks for hypersensitivity and allergic reactions. It does not cause damage to the ears or hearing loss. If a client on Penicillin G experiences symptoms, the nurse should assess for signs of anaphylaxis or skin rashes rather than focusing on auditory or vestibular functioning.
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