A male client with heart failure who takes spironolactone reports painful breast enlargement. Which response by the nurse is most appropriate?
1Explain that breast enlargement indicates fluid retention and that the spironolactone dose will likely be increased.
2Explain that gynecomastia can occur with spironolactone and notify the provider to review the therapy.✓ Correct answer
3Advise the client to stop spironolactone today and begin an over-the-counter potassium supplement.
4Reassure the client that the symptom is unrelated to medication and arrange routine follow-up next year.
Explanation
Gynecomastia and breast tenderness are recognized, dose-related adverse effects of spironolactone. The nurse should acknowledge the possible medication relationship and notify the provider to review therapy; a more selective aldosterone antagonist may be considered when clinically appropriate. The client should not independently stop heart-failure therapy or take potassium, because spironolactone can cause hyperkalemia. The finding should not be dismissed as unrelated or deferred for a year.
Clinical reasoning summary Spironolactone blocks androgen receptors as well as aldosterone receptors, so gynecomastia and breast tenderness can occur. Notify the provider to review therapy and continue potassium and renal monitoring. Do not tell the client to stop the medication independently or add potassium.