Before administering spironolactone, the nurse notes a potassium level of 5.8 mEq/L and new muscle weakness. Which action should the nurse take?
1Give the spironolactone with a banana and repeat the potassium level at the next visit.
2Hold the dose, notify the prescriber, and anticipate ECG and repeat potassium assessment.✓ Correct answer
3Administer the dose, restrict oral fluids, and encourage the client to rest in bed.
4Give the medication with a potassium supplement and recheck the muscle strength later.
Explanation
Spironolactone is a potassium-sparing diuretic. A potassium level of 5.8 mEq/L with muscle weakness suggests clinically important hyperkalemia, so the nurse should hold the dose, notify the prescriber, and anticipate cardiac and laboratory evaluation. Giving spironolactone, potassium-rich food, or a potassium supplement can worsen the hyperkalemia. Fluid restriction does not correct the immediate electrolyte risk.
Clinical reasoning Spironolactone can cause hyperkalemia, especially when combined with potassium supplements or other medications that increase potassium. Weakness with an elevated potassium level requires prompt evaluation.
Decision rule Hold a medication that can worsen a significant electrolyte abnormality and escalate for ECG, repeat laboratory testing, and treatment orders.
Potassium-sparing diuretic — A diuretic class that limits potassium loss; spironolactone can therefore cause clinically significant hyperkalemia.
Hyperkalemia — An elevated serum potassium level that can cause weakness and dangerous cardiac conduction disturbances.