See below for additional resources including:
- 25 new NCLEX style questions, also includes the 3 in the video.
- Written Summery of Aldactone
- An audio recording of the video, which you can find here: https://goo.gl/BWV6Yd
Nursing Exam or NCLEX Style Questions: Aldactone:
1. The doctor ordered spironolactone (Aldactone) to a client diagnosed with heart failure secondary to hyperaldosteronism. Which of the following medication will be a necessary reason for dosage adjustment if this medication is being taken by the client.
A. Warfarin Sodium (Coumadin)
B. Potassium Chloride (Klor-Con)
C. Verapamil hydrochloride (Calan SR)
D. Alprazolam (Xanax)
Answer: B – Spironolactone (Aldactone) is classified as a potassium-sparing diuretic (water pill). One caution when taking spironolactone is the risk of hyperkalemia if being taken with another potassium supplement or substitute. So dosage adjustment may be necessary if being taken with Potassium Chloride. There’s no need for dosage adjustment if the client is taking any of the options A, C and D.
2. The nurse is giving health teaching to a client receiving spironolactone (aldactone) therapy. Which of the following food selection indicates clients’ understanding about the medication?
A. Strawberry jam
Answer: D – Due to the risk of hyperkalemia when taking spironolactone. Food high in potassium should be avoided. Option A, B and C are foods high in potassium.
3. A client receiving furosemide (Lasix) was also given spironolactone (Aldactone) therapy. Which of the following statement of the nurse indicates knowledge about the reason why both drugs are given together?
A. The combination of these drugs promotes diuresis but decreases the risk of hypokalemia.
B. A combination of two diuretics in a moderate doses is much more effective than one type in a large dose.
C. Combination of these drugs increases osmolality of plasma and glomerular filtration rate.
D. Combination of these drugs prevents dehydration and hypovolemia
Answer: A – Furosemide (Lasix) is a potassium-losing diuretic. By giving it together with spironolactone (Aldactone) which is a potassium-sparing diuretic reduces the risk of electrolyte imbalance specifically hypokalemia.
4. A client with hyperaldosteronism has been given spironolactone (Aldactone). Which of the following laboratory result finding will the nurse evaluate as a positive outcome of the medication?
A. Decrease of potassium level
B. Decreased ankle edema
C. Decreased crackles in the lungs
D. Decreased aldosterone
Answer: D – Spirinolactone (Aldactone) is the direct antagonist of aldosterone.
5. A client that is taking spironolactone (Aldactone) is asking for potassium supplement. Which of the following is the best response of the nurse?
A. “I will call your doctor right away and let him know about your concern”
B. “You are correct. I’ll be back to get you what you want”
C. “Potassium supplements are usually not necessary with this type of diuretic”
D. “Your drug is a potassium-sparing diuretic, so there is no need for extra potassium”
Answer: D – Spironolactone (Aldactone) is a potassium-sparing diuretic, thus, client do not the need any potassium supplement since they will be at risk of developing hyperkalemia. Even though option C is true that supplement are usually not given to with this type of diuretic, a more precise explanation with why potassium is not given is still a better response.
6. A laboratory result of a client taking spironolactone (Aldactone) for hypertension came in. Result shows a potassium level of 6 mEq/L. Which of the following will be the nurse’s priority to assess:
A. Electrocardiogram (ECG) results
B. Bowel sounds
C. Respiratory rate
D. Neuromuscular function
Answer: A – Despite the fact that changes in all these findings are seen in hyperkalemia, ECG results should be taken priority on the grounds that changes can indicate potentially deadly arrhythmias, for example, ventricular fibrillation.
7. The nurse is reviewing the medication history of the client prescribed with spironolactone (Aldactone). The nurse contacts the health care provider if the nurse see’s which of the following drugs listed in the medication history of the client?
A. Furosemide (Lasix)
B. Morphine Sulfate
C. Docusate Sodium (Colace)
D. Captopril (Capoten)
Answer: D – Captopril (Capoten) belongs to the drug classification ACE inhibitor. ACE inhibitor can have a drug interaction with spironolactone (aldactone) because ACE inhibitor itself can increase blood levels of potassium, and spironolactone (aldactone) is a potassium-sparing medication because this may result excessive blood potassium level which can be lethal.
8. The health care provider prescribed furosemide (Lasix) and spironolactone (Aldactone) to a client. Before administering the medication the nurse check the potassium level of the client which was 3.2 mEq/L. Besides, notifying the health care provider of the result, which of the following action should the nurse anticipate to take?
A. Holding the medication administration of the spironolactone (Aldactone)
B. Administer the spironolactone (Aldactone) only.
C. Giving the furosemide (Lasix) only.
D. Administer both the furosemide (Lasix) and spironolactone (Aldactone)
Answer: B – Normal potassium level is 3.5 – 5.0 mEq/L and the client has a low potassium level of 3.2 mEq/L. Furosemide (Lasix) is a potassium-losing diuretic, it should not be given to the client since client’s potassium level is already low. While, spironolactone (Aldactone) is a potassium-sparring diuretic so there is no reason for it to hold, instead it should be administered.
9. A client with unilateral adrenalectomy is taking spironolactone. Which of the following possible side effects will the nurse warns to the client?
A. Hair loss
B. Increase libido
C. Menstrual irregularities
D. Increased facial hair
Answer: C – Side of effects of spironolactone (aldactone) may include menstrual irregularities and decreased libido. Men may experience gynecomastia and impotence. Increase libido, increased facial hair, and hair loss aren’t associated with taking spironolactone.
10. A client with hyperaldosteronism has been prescribed with spironolactone (Aldactone). Which of the following indicates that the medication is effective?
A. A decreased in sodium excretion
B. A decreased in body metabolism
C. A decreased in potassium level
D. A decreased in blood pressure
Answer: D – Spironolactone (Aldactone) is an antagonist of aldosterone. Reversing the effect of aldosterone by decreasing circulatory volume by inhibiting reabsorption of water and sodium. Which in turn results to decrease in blood pressure and excretion of sodium and water while retaining potassium. It has no effect in body metabolism.
11. The nurse is preparing to administer the medication spironolactone (Aldactone) to her client. Before administering the medication the nurse did an assessment. Which date will indicate the need to withhold the administration of the medication?
A. Apical pulse rate of 58 beats per minute
B. Blood pressure of 130/90 mmHg
C. Potassium level of 5.8 mEq/L
D. Urine output of 30 mL/hr
Answer: C – Spironolactone (Aldactone) belongs to a class of drugs known as potassium-sparing diuretic. Normal potassium level is 3.5 – 5.0 mEq/L. In this situation the client’s potassium level is high; therefore the medication should be held, and the physician should be notified. Options A, B and D are not affected.
12. A client diagnosed with hypertension has been receiving spironolactone (Aldactone) which of the following health instruction should the nurse provide to the client?
A. “Avoid salt substitute”
B. “Take daily potassium supplements”
C. “Discontinue sodium restrictions”
D. “Eat foods high in potassium”
Answer: A – When taking spironolactone the client should avoid salt substitute because they contain potassium. The client should avoid potassium rich foods and supplements because spironolactone is a potassium-sparing diuretic. Sodium restriction may be continued to reduce fluid volume overload.
13. A client under spironolactone (Aldactone) therapy request assistance with dietary food selection. As a knowledgeable nurse which of the following should be recommended? Select all that apply.
A. Lean meat
Answer: A, B, and E – while under spironolactone therapy, foods high in potassium should be avoided due to the risk of developing hyperkalemia. Options C and D are foods high in potassium.
14. The physician ordered spironolactone (aldactone) to an infant with congenital heart disease. While preparing for the administration of the medication, the nurse understand that the main purpose of the medication is to:
A. Cause dilation of the blood vessels
B. Prevent the secretion of potassium
C. Block aldosterone, which lead to diuresis
D. Preserve the patent ductus arteriosus.
Answer: C – Option A is incorrect because aldactone does not cause vasodilation. Option B is incorrect because aldactone is a potassium-sparing diuretic. Option D is incorrect because aldactone does not affect ductus arteriosus. Aldosterone is a diuretic that blocks aldosterone. Use of this medication is common in children with congenital heart disease for the prevention and treatment of congestive heart failure.
15. Sprinolactone (Aldactone is prescribed to a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following potential side effect of the medication?
B. Yellowish discoloration of the body
D. Increase plasma potassium
Answer: D – Spironolactone (Aldactoe) is a potassium-sparing diuretic so clients should be closely monitor for increase plasma level or hyperkalemia. Tachycarida, yellowish discoloration of the body and constipation are not expected side effects of the spironolactone.
16. Upon checking the laboratory result of the client taking prescribed with spironolactone (Aldactone), which data would be a potential concern?
A. Serum potassium level of 5.5 mEq/L
B. Serum calcium level of 10.2 mg/dL
C. Serum magnesium level of 2.0 mg/dL
D. Serum sodium level of 141 mEq/L
Answer: A – Spironolactone (Aldactoe) is a potassium-sparing diuretic so clients should be closely monitor for increase plasma level or hyperkalemia. Normal serum potassium level is 3.0 -5.0 mEq/L.
17. A nurse nursing diagnosis for a client taking with spironolactone (aldactone) was “Disturbed body image”. Which of the following assessment finding was it based upon?
B. Weight gain
Answer: D – Taking spironolactone may cause body changes because of it antiandrogenic effect to the body. These body image changes are related to decreased libido, gynecomastia in males, and hirsutism in females. Since the medication is diuretic, edema and weight gain should not occur. Excitability is not associated with this medication, rather drowsiness may occur.
18. What is the pharmacologic mechanism of action of Spironolactone (Aldactone)?
A. Stimulate potassium excretion and sodium retention
B. Increase potassium and sodium excretion
C. Promote potassium retention and sodium excretion
D. Promote potassium, sodium and water excretion
Answer: C – Spironolactone (Aldactone) belongs to a classification of drugs known as potassium-sparing diuretic. It promotes discharge of salt and water through the urine while retaining potassium.
19. A client has been admitted and diagnosed of acute myocardial infarction 5 months ago. He was given spironolactone (Aldactone) 25 mg daily to aid in treating irregular heart rate. The client’s potassium level in the blood should be closely monitored. If the serum potassium level is 5.6 mEq/L, what is the priority nursing intervention that the nurse should do?
A. The aldactone dose should be increased and instruct client to decrease foods rich in potassium.
B. The aldactone dose should be reduced or stopped and instruct the client to decrease foods rich in potassium.
C. The aldactone dose should be continued as is and encouraged client to eat more fruits, vegetables and meats.
D. The aldactone dose should be decreased and instruct client to increase intake of foods rich in potassium
Answer: B – normal serum potassium level is 3.5 – 5.0 mEq/L. The client is having hyperkalemia which is one of the possible side effect of taking aldactone which can be lethal if uncontrolled. Medication should be stopped or decrease in dose and instruct client to avoid/decrease foods rich in potassium.
20. Which statement by the client, undergoing spironolactone (Aldactone) therapy, indicates understanding of the health teaching?
A. “I will make sure to eat foods that are high in potassium”
B. “I will avoid foods such as bananas, apricot and strawberry”
C. “I will make sure not to drink grapefruit juice while on this medication”
D. “I can eat anything with this kind of medication”
Answer: B – Client’s under spironolactone (Aldactone) medication should avoid foods rich in potassium, such as bananas, apricot and strawberry. This will increase the risk of hyperkalemia. Drinking grapefruit has nothing to do with this medication.
21. Potassium supplement and salt substitute should not be given to which classification medications?
B. Loop diuretic
C. Potassium – losing diuretic
D. Potassium – sparing diuretic
Answer: D – Potassium – sparing diuretic is a medication that promotes excretion of sodium and water but retain potassium. Potassium supplement and salt substitute should not be given in this type of medication due to the risk of developing hyperkalemia which can have a lethal effect. Option A, B, and C types of medication can be given with potassium supplements because they are excrete sodium and water as well as potassium.
22. A 54-year old client diagnosed with heart failure is allergic to sulfate-based medication. Which type of diuretic should the client avoid?
A. Potassium – sparing diuretic
B. Thiazide and thiazide-like diuretics
C. Osmotic diuretics
D. Loop diuretics
Answer: B – thiazide and thiazide-like diuretics are sulfonamide derivatives, so use of this medication should be avoided in clients that has allergy to sulfa-based medications. Osmotic, potassium-sparing, and loop diuretics are drugs that can be safely taken to these clients. Although, loop diuretics are most commonly given for the treatment of heart failure.
23. The nurse reviews the electrolyte results of her client and noted that the serum potassium level is 5.5 mEq/L. Which of the following ECG value will the nurse expects to see on the ECG result?
A. ST depression
B. Inverted T wave
C. Prominent U wave
D. Flat P waves
Answer: D – Serum potassium level higher than 5.1 mEq/L indicates hyperkalemia. ECG change in these condition may include flat P waves, prolonged PR intervals, widened QRS complexes and tall peaked T wave.
24. A client has been prescribed with spironolactone (Aldactone) for the management of hyperaldosteronism. Which of the following statement by the client indicates the need for further teaching?
A. “If I miss a dose, I can double the dose on the next dose to catch up the missed one”
B. “I would store this medication on a room temperature without direct sunlight”
C. “I would try to avoid food such as potatoes and tomatoes”
D. “I would avoid driving while on this medication”
Answer: A – It is very essential to take medication as prescribed. In taking spironolactone (aldactone), once you missed a dose, take it as soon as you remember, but if it is near the time for the next dose, skip the missed and resume usual dosing schedule. Do not double dose. Option B is correct, option C is correct since potatoes and tomatoes are food high in potassium which should be avoided while on this medication. Driving may not be recommended because of the possible side effect of the medication which is drowsiness, dizziness and confusion.
25. Which of the following individual should not take spironolactone (Aldactone)? Select all that apply.
A. A client with hyperaldosteronism
B. A client who had difficulty urinating
C. A client with serum potassium level of 5.8 mEq/L
D. A client who had been diagnosed with Addison’s disease
E. A that has ascites
Answer: B, C, and D – Spirnolactone (Aldactone) is contraindicated to individuals with the conditions such as: unable to urinate, has significant impairment of the renal excratory function, acute kidney injry, high potassium level in the blood, have allergic reaction to the medication, pregnant/planning to get pregnant, breastfeeding mothers and Addison’s disease.
Written Summery: Aldactone:
Spironolactone is a type of potassium-sparing diuretic also known as a water pill. It is sold under the brand name of Aldactone.
Spironolactone is a particular pharmacologic antagonist of aldosterone. The word Antagonist in medical terms means – a substance that blocks an action and aldosterone is a steroidal hormone which is produced by the adrenal cortex.
One of the greatest benefits of using this diuretic is that it prevents the blood potassium levels from dropping too low as it stops the body from absorbing too much salt. So it has a dual purpose by being an effective antihypertensive drug, and also is effective for the treatment of edema, which might happen in a nephrotic syndrome, cirrhosis of the liver and congestive heart failure.
Mechanism of action:
Blood pressure depends on the level of water and salt in the bloodstream, and kidneys have the capacity to hold salt and water. The adrenal cortex releases a steroid hormone or mineralocorticoid known as aldosterone, which plays an important role in regulating blood pressure. It causes the kidneys to reabsorb sodium and water and discharge potassium, this increases blood pressure. But sometimes when the mechanism becomes dysfunctional, it causes aldosterone to behave pathogenically and increases the risks of kidney and cardiovascular diseases which is more serious in those persons who are already at risk.
Spironolactone reverses the action of aldosterone and causes the kidneys to preserve potassium while discharging sodium and water through the urine. It does so by attaching to the aldosterone receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted tubule of the kidney. Therefore, spironolactone is considered to be a potassium-sparing diuretic as it increases urine output while retaining potassium. When there is lower water volume in the blood, blood pressure decreases. Which explains why in hypertension, the level of water in the bloodstream is high. As a diuretic, spironolactone is not very effective if used alone, as it only affects the collecting tubules where only a low level of sodium is retained. For better results, it can be used with other diuretics.
You will see (Aldactone) used to treat several conditions:
It may be prescribed to the hypertensive patients as an anti-hypertensive and diuretic. It is mainly used to treat congestive heart failure and edema that occurs in patients with cirrhosis of the liver and nephrotic syndrome. It is also used to treat hypokalemia, and basic hyperaldosteronism.
Other off label uses of Spironolactone include its anti-androgenic effect. It acts as a strong antagonist of the androgen receptors, preventing the formation of androgen. Certain doctors prescribe it for this property to cure combination conditions caused by androgens (types of androgens include: testosterone and dihydrotestosterone). Some common conditions are hirsutism (when a woman grows body hair where it normally doesn’t grow), acne, hyperandrogenism in polycystic ovary syndrome (causing very painful menstrual periods), seborrhea in women and androgenic alopecia or (baldness) in men, but excessive use for men is not advisable as the drug carries risks of feminization.
Spironolactone (Aldactone) should not be prescribed to people who have:
Severe renal injury
Serious renal excretory dysfunction
Anuria, (meaning that the individual cannot urinate)
Hyperkalemia, (which is high blood potassium level)
And those who are allergic to this drug
Also pregnant women, or those who are planning to get pregnant as well as breasfeeding mothers need to be aware that this medication is in pregnancy category C (Category C)
The drug can cause adverse reactions, here are some of them:
Occasionally side effects of spironolactone might be severe. They appear rarely, but if they do, instruct your patient to seek medical help immediately. If any of the following serious side effects appear, the situation can be serious and even lethal.
Swelling of the face, mouth, lips or tongue; itching, hives, rashes, tightness in the chest, and difficulty in breathing.
Abnormal bleeding or bruising
Black, tarry, and/or bloody stools
Irregular or missed menstruation
Severe or consistent stomach pain
Consistent sore throat
Yellowing of the skin or eyes
Fast/slow or irregular heartbeat
There can be more side effects besides the above mentioned list, and you, as the nurse should listen carefully to all the symptoms that your patient describes. These symptoms should be documented and reported to the physician..
Nurses should be particularly aware of Spironolactone’s interaction with other drugs:
Certain drugs used for a long time, or at a specific time, may increase the risk of major side effects of spironolactone or change its effects.
Interaction with ACE inhibitors or NSAIDs can lead to serious hyperkalemia
NSAIDs also reduce its diuretic effects.
Interaction with lithium can cause lithium toxicity as diuretics also cause the kidneys to discharge less lithium.
Interaction with digoxin can lead to digitalis toxicity as spironolactone increases the half-life of digoxin which raises the level of serum digoxin.
With Corticosteroid, ACTH, it leads to electrolyte depletion, especially hypokalemia.
With Narcotics, Alcohol or Barbiturates it increases the risk of orthostatic hypotension.
There are more drug interactions of the medication outside this list, be aware of your patient’s reactions and symptoms.
Special considerations on proper dosage, handling and storage:
For children dosage is based on body weight.
For adults, the recommended daily dose is 25 mg to 400 mg depending on the requirement of the treatment.
The medication can be used in single or divided doses.
It can be taken with or without food. If it upsets the stomach, it should be taken with food.
It is recommended to be taken early in the day or before 6 pm to avoid the discomfort at night due to frequent urination.
It is important to take Aldactone exactly as prescribed. The dosage should not be increased, decreased or stopped without consulting the doctor. A sudden discontinuation of the drug can worsen the condition.
If a dose is missed, it should be taken as soon as the patient remembers. If it is close to the time for the next dose, the missed dose should be skipped. The patient should not double the dose to make up for the missed dose.
Special Precautions and Warnings:
Alert your patient of the importance of discussing his medical history and allergies with the doctor before using this medication.
Aldactone increases blood potassium level. Alert your patient to the risks of increasing or decreasing the use of his prescribed potassium supplements, or, foods containing high levels of potassium, like tomatoes, bananas, potatoes and salt substitutes.
Be sure to inform your patient of the importance of letting the provider know that he is using aldactone before taking any drugs for other conditions such as dental care, surgery or during an emergency.
Inform your patient to avoid alcohol.
For safety purposes, avoid driving, using machinery or any activity that needs alertness.
Children and elders should be given the medication with extra caution, as they may be more sensitive to the effects and side effects of the drug.
Lab tests such as blood electrolyte levels, blood pressure and renal function test should be carried out with regularity while using aldactone. Because the drug may influence lab results, the patient should always mention that he is using aldactone to the health workers while taking any tests.
Nurses, be sure to stress the importance of keeping follow up appointments with his or her doctors and educate him on the need for regular lab test.
Aldactone has proven to be effective therapy for many persons. As your patient’s nurse always be alert to what your patient is telling you.
And always take the opportunity to educate your patient about the drugs that you are administering to them and always listen to their comments referring to the drug’s effects and side effects. Always document appropriately and inform the provider with information as necessary. YOU are you patient educator and best advocate!