Potassium-Sparing Diuretics

Every question here, with the answer

1. A client taking spironolactone says, "My water pill makes me lose potassium, so I use a salt substitute and eat extra bananas." What is the nurse's best response?

   1. "That is a good way to replace lost potassium."
   2. "Salt substitutes are fine, but avoid bananas."
   3. "Eat bananas but only with the dose."
   4. "This drug keeps potassium in your body, so salt substitutes and extra potassium-rich foods can raise your potassium too high."

   Answer: "This drug keeps potassium in your body, so salt substitutes and extra potassium-rich foods can raise your potassium too high."

   Potassium-sparing diuretics decrease potassium excretion, so clients are cautioned about salt substitutes, bananas and other potassium-rich foods. Clients often wrongly link all water pills with a need for extra potassium.

2. Which laboratory result is the priority for a client taking a potassium-sparing diuretic?

   1. Hemoglobin
   2. Serum albumin
   3. Serum potassium
   4. Platelet count

   Answer: Serum potassium

   Clients taking potassium-sparing diuretics are at risk for hyperkalemia, which can cause arrhythmias and cardiac arrest if untreated. The other labs are not the main concern named in the section.

3. A male client has taken spironolactone for several months. Which findings should the nurse recognise as possible endocrine effects of the drug? Select all that apply.

   1. Enlarged breasts
   2. Other feminizing effects
   3. Increased muscle mass
   4. Hair loss on the scalp
   5. Decreased libido

   Answer: Enlarged breasts, Other feminizing effects, Decreased libido

   Spironolactone can cause gynecomastia, decreased libido and other feminizing effects in male clients. Hair loss and increased muscle mass are not listed.

4. A client just started a potassium-sparing diuretic and on day 2 says it "isn't working." What should the nurse explain?

   1. The onset of action can be delayed by as much as 3 days.
   2. The drug only works when taken with bananas.
   3. The drug should be stopped because it is ineffective.
   4. The dose should be doubled right away.

   Answer: The onset of action can be delayed by as much as 3 days.

   Potassium-sparing diuretics have a weaker action, and onset can be delayed by as much as 3 days. Stopping or doubling the dose without the provider is not supported.

5. In which clients is a potassium-sparing diuretic contraindicated or used with caution? Select all that apply.

   1. A client with renal insufficiency
   2. A client with hyperkalemia
   3. An older adult client with diabetes
   4. A client with hypokalemia from a loop diuretic
   5. A client with anuria

   Answer: A client with renal insufficiency, A client with hyperkalemia, An older adult client with diabetes, A client with anuria

   Contraindications include anuria, hyperkalemia and renal insufficiency, and caution is needed in older adults and clients with diabetes or gout. Hypokalemia from loop diuretics is a reason these drugs are used.

6. A client taking a potassium-sparing diuretic asks about taking an over-the-counter anti-inflammatory for back pain. What should the nurse say?

   1. "Stop your diuretic while you take it."
   2. "Take it with a potassium supplement."
   3. "Check with your health care provider first, because these can increase potassium levels."
   4. "Any anti-inflammatory is safe with this drug."

   Answer: "Check with your health care provider first, because these can increase potassium levels."

   Clients taking potassium-sparing diuretics should not take NSAIDs without consulting the provider because they can increase potassium levels. Adding potassium or stopping the diuretic on their own is not advised.