A nurse is preparing to administer morning medications. The nurse notes that a patient with a history of hypertension is taking captopril (Capoten) concurrently with spironolactone (Aldactone)

Question

Morning laboratory results reveal a serum sodium level of 144 mg/dL, a serum potassium level of 4.5 mEq/L, and a blood glucose level of 128 mg/dL. Which of the following interventions should the nurse use?
a. Administer the medications as ordered.
b. Clarify the order with the prescriber.
c. Confer with the prescriber about increasing the captopril dose.
d. Request that the spironolactone be changed to mannitol (Osmitrol).

Answer 1

ANS: B
Spironolactone should not be administered with angiotensin-converting enzyme (ACE) inhibitors, which can also elevate potassium levels. Because the potassium level is on the high end of the spectrum, the nurse should not administer the medication and should obtain clarification of the order.
Conferring with the prescriber about increasing the captopril dosage is not indicated or appropriate.
Requesting that spironolactone be changed to mannitol is unmerited, because indications for mannitol include prophylaxis of renal failure, reduction of intracranial pressure, and reduction of intraocular pressure, not the management of hypertension.
The medications should not be administered as ordered. Spironolactone should not be administered with captopril.