Pharmacology Antihypertensives #6

Question

The nurse is caring for a patient in the telemetry unit who was prescribed spironolactone prior to experiencing cardiac symptoms. On admission, the patient is demonstrating ECG changes and is experiencing muscle weakness. A priority outcome for the patient is for resolution of which electrolyte imbalance?

Answers

  1. Hypokalemia
    • Rationale:

      This answer is not correct because spironolactone is a potassium sparing (not wasting) diuretic which makes the patient at risk for hyperkalemia, not hypokalemia.

  2. Hyperkalemia
    • Rationale:

      This answer is correct because spironolactone is a potassium sparing diuretic which makes the patient at risk for hyperkalemia. Normal potassium levels are 3.5-5.3 mmol/L, so > 5.0 is considered hyperkalemia. Symptoms associated with hyperkalemia include numbness, nausea, weakness, irregular heartbeat, and heart arrhythmias.

  3. Hypocalcemia
    • Rationale:

      This answer is not correct because decreased calcium is not associated with spironolactone use. Spironolactone is a potassium sparing diuretic which makes the patient at risk for hyperkalemia.

  4. Hypercalcemia
    • Rationale:

      This answer is not correct because increased calcium is not associated with spironolactone use. Spironolactone is a potassium sparing diuretic which makes the patient at risk for hyperkalemia.

Overview

Spironolactone is a diuretic medication and has the risk of hyperkalemia. Symptoms associated with hyperkalemia include muscle weakness and ECG changes.

Explanation

The correct answer is B. Spironolactone is potassium sparing and may induce hyperkalemia which would result in cardiac symptoms. ECG changes would reflect potassium imbalances along with symptoms described above, thus priority outcome is normalizing potassium imbalance.

Learning Outcomes

Spironolactone is prescribed to reduce excess fluid in the body in conditions such as heart failure or hypertension. Spironolactone is a potassium sparing diuretic which makes the patient at risk for hyperkalemia. Normal potassium levels are 3.5-5.3 mmol/L, so > 5.0 is considered hyperkalemia. Symptoms associated with hyperkalemia include numbness, nausea, weakness, irregular heartbeat, and heart arrhythmias.

Test Taking Tip

Always check the patient’s blood pressure and potassium levels when administering furosemide.

Video Rationale