A nurse is caring for a client who has prescriptions for spironolactone and lisinopril. The nurse should monitor for which of the following effects?

Choice A rationale Hypoglycemia, or low blood glucose, is not a common or direct interaction effect between spironolactone and lisinopril. Spironolactone is a potassium-sparing diuretic, and lisinopril is an ACE inhibitor; neither medication is directly involved in glucose regulation pathways to cause hypoglycemia. Normal fasting blood glucose is 70-99 mg/dL. Choice B rationale Hyperkalemia, an elevated potassium level, is a significant risk when spironolactone and lisinopril are co-administered. Spironolactone is a potassium-sparing diuretic, and lisinopril, an ACE inhibitor, also reduces aldosterone secretion, both mechanisms lead to decreased potassium excretion and increased serum potassium. Normal potassium is 3.5-5.0 mEq/L. Choice C rationale Hyperglycemia, or elevated blood glucose, is not a typical adverse effect of either spironolactone or lisinopril, nor is it a known interaction effect between the two. These medications do not directly impact insulin sensitivity or glucose production pathways in a manner that would lead to hyperglycemia. Normal fasting blood glucose is 70-99 mg/dL. Choice D rationale Hypokalemia, or low potassium levels, is highly unlikely with the co-administration of spironolactone and lisinopril. Both medications tend to increase or conserve potassium. Spironolactone directly spares potassium, and lisinopril indirectly increases potassium by inhibiting aldosterone, thus preventing potassium excretion. Normal potassium is 3.5-5.0 mEq/L.