A nurse is caring for a client who has heart failure and is receiving spironolactone (Aldactone). Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? (Select all that apply)

The correct answer is A, C, E.

Choice A reason:

Hyperkalemia is a known adverse effect of spironolactone because it is a potassium-sparing diuretic. This means it prevents the excretion of potassium, which can lead to elevated levels of potassium in the blood. Normal potassium levels range from 3.5 to 5.0 mEq/L.

Choice B reason:

Hypokalemia is unlikely with spironolactone use because, as a potassium-sparing diuretic, it typically leads to increased potassium levels, not decreased.

Choice C reason:

Gynecomastia, or enlargement of male breast tissue, is an adverse effect of spironolactone. This is likely due to its antiandrogenic effects, which can interfere with hormone levels.

Choice D reason:

Menorrhagia, or heavy menstrual bleeding, is not commonly associated with spironolactone. This medication does not typically affect menstrual volume or frequency.

Choice E reason:

Impotence can occur as an adverse effect of spironolactone due to its potential impact on sex hormones. It may cause erectile dysfunction or other issues related to sexual function.

Captopril (Capoten) is an ACE inhibitor that can cause a dry, nonproductive cough as a side effect. This cough may be bothersome and interfere with the quality of life of the client.The client should inform the provider if this occurs, as the medication may need to be changed or adjusted.

Choice A is wrong because captopril should be taken one hour before meals, not with food.Food may decrease the absorption and effectiveness of the medication.

Choice B is wrong because captopril can cause hyperkalemia, or high levels of potassium in the blood, by decreasing aldosterone secretion.The client should avoid foods high in potassium, such as bananas, oranges, potatoes, and tomatoes, and have their potassium levels monitored regularly.

Choice D is wrong because captopril can cause hypotension, or low blood pressure, especially when the client first starts taking the medication or when the dose is increased.The client should take captopril in the morning or during the day, not at bedtime, to avoid orthostatic hypotension and falls.The client should also rise slowly from a sitting or lying position and report any symptoms of dizziness, lightheadedness, or fainting to the provider.