A client is currently prescribed pantoprazole, and the nurse is reviewing the client's labs (shown below). Which lab result is of most concern to the nurse?

Laboratory Test

Result

Normal Range

Sodium

146 mEq/dL

135-145 mEq/L

Calcium

8.2 mg/dL

8.4-10.2 mg/dL

Magnesium

1.2 mg/dL

1.6-2.2 mg/dL

Gastric pH

6

1-4

Sodium

Gastric pH

Calcium

Magnesium

Answer and Explanation

The Correct Answer is D

A. Sodium: Sodium levels are important to monitor, but in the context of pantoprazole use, abnormal sodium levels are less commonly a direct concern. Pantoprazole primarily impacts the gastric environment rather than fluid or electrolyte balance in a way that would dramatically alter sodium levels.

B. Gastric pH: Pantoprazole works to increase gastric pH by reducing acid secretion, which is its primary therapeutic effect. A higher gastric pH is expected and beneficial in conditions like GERD or peptic ulcers.

C. Calcium: Pantoprazole, when used for extended periods, can interfere with calcium absorption, potentially leading to bone health issues like osteoporosis. However, changes in calcium levels typically do not pose an immediate or life-threatening concern unless significantly low or related to prolonged therapy. It is still something to monitor, but magnesium is a higher priority in this case.

D. Magnesium: Pantoprazole and other proton pump inhibitors (PPIs) are known to cause hypomagnesemia, especially with prolonged use. Low magnesium levels can lead to serious complications, including muscle spasms, seizures, and arrhythmias. Hypomagnesemia is a well-documented side effect of long-term PPI use, making it the most critical lab result to address.

Nursing Test Bank

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Correct Answer is B

Explanation

A) "I will avoid alcohol and cigarettes.": This is a correct and important statement for a client with GERD. Both alcohol and cigarettes can relax the lower esophageal sphincter, increasing the likelihood of acid reflux and exacerbating GERD symptoms. Avoiding these substances is a standard recommendation for managing GERD.

B) "I will have a small snack right before bedtime.": This statement indicates the need for additional education. Eating a meal or snack right before bedtime can exacerbate GERD symptoms because lying down after eating can increase the likelihood of acid reflux. It is generally recommended for clients with GERD to avoid eating at least 2-3 hours before going to bed to reduce the risk of reflux.

C) "I will wear loose fitting clothes.": Wearing loose-fitting clothes is an appropriate measure for managing GERD. Tight clothing around the abdomen can increase pressure on the stomach, promoting acid reflux. Loose clothing helps avoid this additional pressure, which can alleviate symptoms.

D) "I will take all NSAIDs and steroids with food.": This is generally good advice for reducing the risk of stomach irritation caused by NSAIDs and steroids, which can worsen GERD symptoms or cause gastric ulcers. Taking these medications with food can help buffer the stomach lining and reduce irritation.

A. True B. False

Correct Answer is A

Explanation

CYP 450 enzymes are responsible for the metabolism of many drugs. Smoking can induce certain CYP 450 enzymes, particularly CYP1A2, which leads to an increase in the metabolism of drugs that are substrates of this enzyme. When a person begins smoking, the induction of these enzymes can cause drugs to be metabolized more quickly, which typically results in lower drug levels in the body. However, the statement asks whether the level of medication will increase in this client, and since smoking induces enzyme activity, it would typically lead to decreased, not increased, drug levels. However, in the context of drug-drug interactions and other metabolic pathways, the metabolism rate could be altered in ways that might increase or affect the therapeutic response.

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Laboratory Test	Result	Normal Range
Sodium	146 mEq/dL	135-145 mEq/L
Calcium	8.2 mg/dL	8.4-10.2 mg/dL
Magnesium	1.2 mg/dL	1.6-2.2 mg/dL
Gastric pH	6	1-4

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with active GERD presents to clinic. Which statement by the client indicates they need additional education?

Correct Answer is B

Explanation

A client currently prescribed a medication highly metabolized by the CYP 450 recently began smoking due to a stressful life event. True or False: The level of medication will increase in this client.

Correct Answer is A

Explanation

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