# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391740&lang=en  
> language: en  
> subject: Medication Administration  
> category: PPT

## 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?

## Option

1. "Once you have a positive pregnancy test, discontinue the phenytoin to protect the developing fetus from harm."
2. "Meet with your neurologist BEFORE conception to discuss safer alternatives and start high-dose folic acid."
3. "Phenytoin is generally safe during pregnancy, but you should start taking a prenatal vitamin with folic acid."
4. "Pregnancy often leads to a significant reduction in seizure frequency, and many women can eventually stop their medication." **✔ Correct answer**

**Correct answer: 4**

## 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.

## In-depth explanation

Memory Tip Anticonvulsants in pregnancy — safest: lamotrigine, levetiracetam. Most teratogenic: valproate (NTD, autism), phenytoin, carbamazepine, topiramate.

## Clinical scenario

Scenario 26-year-old female, seizures well controlled on phenytoin 300 mg daily, plans pregnancy in 6-12 months. Currently on no other medications.

## Key concepts

- **Teratogen** — A substance causing fetal malformation; phenytoin, valproate, carbamazepine are anticonvulsant teratogens.
- **Preconception counseling** — Pre-pregnancy planning visit to optimize chronic disease therapy and start folic acid; mandatory for women with epilepsy on teratogenic medications.
- **Fetal hydantoin syndrome** — Cluster of cleft lip/palate, cardiac defects, and growth retardation from in-utero phenytoin exposure.

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