A client with heart failure (HF) develops hyperaldosteronism and spironolactone is prescribed. Which instruction should the nurse include in this client's plan of care?

Choice A reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Replacing salt with a salt substitute is not recommended for clients taking spironolactone, as most salt substitutes contain potassium. Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, or high levels of potassium in the blood. The client should avoid salt substitutes and other sources of potassium.Choice B reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Monitoring skin for excessive bruising is not related to the use of spironolactone, as it does not affect the blood clotting process. The client should monitor for signs of bleeding, such as nosebleeds, gum bleeding, or blood in the urine or stool, if he or she is taking other medications that can interfere with clotting, such as aspirin or warfarin.Choice C reason: This is not an appropriate instruction for the nurse to include in the client's plan of care. Covering the skin before going outside is not necessary for clients taking spironolactone, as it does not cause photosensitivity or increased risk of sunburn. The client should protect the skin from sun exposure as part of general health promotion, but it is not specific to spironolactone therapy.Choice D reason: This is the appropriate instruction for the nurse to include in the client's plan of care. Limiting intake of high-potassium foods is important for clients taking spironolactone, as it can prevent hyperkalemia and its complications, such as cardiac arrhythmias, muscle weakness, or paralysis. The client should avoid foods that are rich in potassium, such as bananas, oranges, tomatoes, potatoes, spinach, and dairy products. The client should also have regular blood tests to monitor the potassium levels.