A nurse is reviewing the laboratory findings of a client who has liver failure with ascites. The client takes spironolactone. Which of the following findings is an adverse effect of themedication?

Serum chloride 99 mEq/L

Serum calcium 10.5 mg/dL

Serum potassium 5.2

Serum sodium 140 mEq/L.

Answer and Explanation

The Correct Answer is C

a. Serum chloride 99 mEq/L: Serum chloride within the reference range is not an adverse effect of spironolactone.

b. Serum calcium 10.5 mg/dL: Serum calcium within the reference range is not an adverse effect of spironolactone.

c. Serum potassium 5.2: Spironolactone is a potassium-sparing diuretic, and an elevated serum potassium level is an adverse effect that requires monitoring. The nurse should assess for

hyperkalemia.

d. Serum sodium 140 mEq/L: Serum sodium within the reference range is not an adverse effect of spironolactone.

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Correct Answer is A

Explanation

a. Restrict oral fluids to 800 to 1,000 mL/day: Hyponatremia is a characteristic finding in SIADH, and fluid restriction is a key intervention to correct the imbalance.

b. Maintain an IV of 0.45% sodium chloride: Infusing hypertonic (3%) saline may be indicated in severe cases of hyponatremia, but the initial step is fluid restriction.

c. Ensure the client receives a 2 g/day sodium diet: Dietary sodium restriction is not the primary intervention for SIADH. Fluid restriction is more critical.

d. Administer desmopressin acetate 0.2 mg orally: Desmopressin acetate is an antidiuretic

hormone and would exacerbate the retention of water, further decreasing sodium levels. It is not the appropriate intervention for this client.

A. Weight gain B. Constipation C. Frequent mood changes D. Sensitivity to cold

Correct Answer is C

Explanation

a. Weight gain: Hyperthyroidism is more commonly associated with weight loss due to increased metabolism.

b. Constipation: Hyperthyroidism is more likely to cause diarrhea or increased bowel movements.

c. Frequent mood changes: Hyperthyroidism can lead to mood swings, irritability, and anxiety.

d. Sensitivity to cold: Sensitivity to cold is more commonly associated with hypothyroidism, not hyperthyroidism.

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A nurse is reviewing the laboratory findings of a client who has liver failure with ascites. The client takes spironolactone. Which of the following findings is an adverse effect of themedication?

Nursing Test Bank

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