A nurse is caring for a client prescribed Spironolactone. Wh… | MyMerci
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Medication AdministrationPPT
Question
A nurse is caring for a client prescribed Spironolactone. Which nursing action is most appropriate regarding monitoring for signs of hyperkalemia and restricting potassium supplements?
1Protamine sulfate 50 mg IV push over 10 minutes, and a single dose of platelets 1 unit; administer via separate IV line; flush with normal saline before and after; monitor for thrombosis and re-bleeding; resume heparin infusion no sooner than 4 hours after reversal once aPTT is less than 40 seconds and hemodynamically stable.
2Idarucizumab (Praxbind) 5 g IV — administered as two consecutive 2.5 g IV infusions or boluses given within 15 minutes of each other; flush IV line with normal saline before and after; monitor for thrombosis and re-bleeding; resume dabigatran no sooner than 24 hours after reversal once hemodynamically stable.✓ Correct answer
3Vitamin K 10 mg slow IV push, 4-factor prothrombin complex concentrate (4F-PCC) 50 units/kg IV over 15 minutes; administered through separate lines; flush with normal saline before and after; monitor for thrombosis and re-bleeding; resume oral anticoagulant once INR is less than 2.0 and hemodynamically stable.
4Andexanet alfa low-dose protocol (400 mg IV bolus at 30 mg/min, then 4 mg/min infusion for up to 120 minutes); flush IV line with normal saline before and after; monitor for thrombosis and re-bleeding; resume dabigatran no sooner than 6 hours after reversal once hemodynamically stable.
Explanation
When administering Spironolactone, key nursing considerations include monitoring patient status, checking critical laboratory values, and providing appropriate safety education. Unsafe practices such as stopping medications abruptly or doubling missed doses are incorrect.
Clinical reasoning summary Idarucizumab — dabigatran-specific reversal Idarucizumab (Praxbind) is a humanized monoclonal antibody fragment with high affinity for dabigatran (binds ~350× stronger than dabigatran binds thrombin). It rapidly neutralizes the anticoagulant effect.
Indications: • Life-threatening or uncontrolled bleeding in patients on dabigatran. • Emergency surgery or urgent procedures that cannot be delayed.
Administration: • 5 g IV total: given as two 2.5 g doses (each in 50 mL vials) IV bolus or short infusion (~5–10 min) within 15 minutes of each other. • Flush the IV line with NS before and after each vial; do not mix with other medications. • Onset within minutes; effect typically lasts 24 hours. • Repeat 5 g dose may be given if dabigatran resurges or rebound bleeding occurs. • Monitor for thrombosis (because the underlying indication for dabigatran returns once the drug is neutralized). • Resume dabigatran no sooner than 24 hours after reversal — only when hemostasis is achieved and patient is hemodynamically stable; bridge with parenteral anticoagulant if needed.
Other choices: • Vitamin K + PCC reverses warfarin, not dabigatran. • Protamine reverses heparin, not dabigatran. • Andexanet alfa reverses Xa inhibitors (apixaban / rivaroxaban / edoxaban), not the thrombin inhibitor dabigatran; repeat oral dabigatran in 6 hours during active bleed is wrong.