A patient with renal impairment is prescribed a medication that is primarily excreted by the kidneys. What adjustment should the nurse anticipate?

Choice A reason: Serum sodium level of 140 mEq/L is within the normal range of 135145 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not affect sodium excretion significantly. The nurse does not need to notify the health care provider about this finding.
Choice B reason: Blood pressure of 130/80 mmHg is slightly above the normal range of 120/80 mmHg, but it is not a cause for concern. The potassium sparing diuretic can lower the blood pressure by reducing the fluid volume and preventing sodium retention. The nurse should monitor the blood pressure regularly but does not need to notify the health care provider about this finding.
Choice C reason: Serum potassium level of 5.5 mEq/L is above the normal range of 3.55.0 mEq/L. It indicates hyperkalemia, which is a serious and potentially life-threatening complication of the potassium sparing diuretic. The potassium sparing diuretic can increase the potassium level by inhibiting its secretion in the distal tubule of the kidney. The nurse should notify the health care provider immediately and prepare to administer interventions such as calcium gluconate, insulin, or sodium bicarbonate to lower the potassium level and prevent cardiac arrhythmias.
Choice D reason: Serum potassium level of 3.5 mEq/L is at the lower end of the normal range of 3.55.0 mEq/L. It does not indicate any adverse effect of the potassium sparing diuretic, which does not cause potassium loss. The nurse does not need to notify the health care provider about this finding.

Choice A reason: Vasoconstriction is the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. This increases the resistance to blood flow and raises the blood pressure. Phenylephrine is used as a vasopressor to treat hypotension, which is a condition of low blood pressure that can cause dizziness, fainting, or organ damage. The nurse should monitor the blood pressure and the peripheral pulses of the patient after administering phenylephrine.

Choice B reason: Bronchodilation is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has no effect on the beta2 receptors on the bronchial smooth muscle, which are responsible for bronchodilation or widening of the airways. Phenylephrine is not used to treat respiratory conditions, such as asthma or chronic obstructive pulmonary disease, that cause bronchoconstriction or narrowing of the airways. The nurse should assess the respiratory rate and the breath sounds of the patient after administering phenylephrine.

Choice C reason: Diuresis is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has no effect on the kidney function or the urine output. Phenylephrine is not used to treat fluid retention or edema, which are conditions of excess fluid in the body that can cause swelling, weight gain, or heart failure. The nurse should measure the urine output and the specific gravity of the patient after administering phenylephrine.

Choice D reason: Decreased heart rate is not the desired therapeutic effect of phenylephrine in this context. Phenylephrine is a medication that stimulates the alpha1 receptors on the blood vessels, causing them to constrict or narrow. It has little or no effect on the beta1 receptors on the heart, which are responsible for increasing the heart rate and the contractility. Phenylephrine may actually cause a reflex bradycardia, which is a slow heart rate that occurs when the baroreceptors in the blood vessels sense an increase in blood pressure and send signals to the brain to lower the heart rate. Phenylephrine is not used to treat tachycardia, which is a fast heart rate that can cause palpitations, chest pain, or arrhythmias. The nurse should monitor the electrocardiogram and the heart rate of the patient after administering phenylephrine.