# 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=ja  
> language: ja  
> subject: Medication Administration  
> category: PPT

## 問題

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?

## 選択肢

1. "妊娠検査が陽性になったら、胎児への害を防ぐためにPhenytoinを中止してください。"
2. 「妊娠前に神経内科医へ相談し、より安全な代替薬と高用量葉酸の開始を話し合ってください。」
3. "Phenytoinは妊娠中も一般的に安全ですが、葉酸を含む妊婦用ビタミンを摂取し始めるべきです。"
4. "妊娠により発作頻度が大幅に減少することが多く、多くの女性が最終的に薬を中止することができます。" **✔ 正解**

**正解: 4**

## 解説

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.

## 詳細解説

覚え方 妊娠中の抗けいれん薬：比較的安全なのはlamotrigine、levetiracetam。催奇形性が高いのはvalproate、phenytoin、carbamazepine、topiramate。

## 臨床シナリオ

シナリオ 26歳女性。発作はphenytoin 300 mg dailyで良好にコントロールされ、6-12か月以内の妊娠を計画している。他の薬は使用していない。

## 重要概念

- **催奇形因子** — 胎児奇形を引き起こす物質。phenytoin、valproate、carbamazepineは抗けいれん薬の催奇形因子。
- **妊娠前カウンセリング** — 妊娠前に慢性疾患治療を最適化し葉酸を開始する面談。催奇形性薬を使うてんかん女性では必須。
- **胎児ヒダントイン症候群** — 胎内phenytoin曝露により口唇口蓋裂、心奇形、発育遅延がまとまって起こる症候群。

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