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

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.

A) This medication neutralizes gastric acid in the stomach by direct contact: Sucralfate does not neutralize gastric acid. Instead, it works by forming a protective barrier over the ulcer, which helps protect it from further damage by stomach acid and promotes healing. Sucralfate is a mucosal protectant, not an acid-neutralizing agent.

B) "You should take this medication after meals to help limit gastric acid secretion": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals, to allow it to form an effective protective barrier over the ulcer. Taking it after meals would interfere with its action and effectiveness.

C) "This medication decreases gastric acid production by blocking histamine 2 receptors": Sucralfate does not work by blocking histamine 2 receptors. Histamine 2 receptor antagonists, such as ranitidine, work by reducing gastric acid secretion. Sucralfate works by coating and protecting the ulcer rather than by reducing acid production.

D) "You should take this medication 30 minutes to 1 hour before meals and at bedtime": Sucralfate should be taken on an empty stomach, typically 30 minutes to 1 hour before meals and at bedtime. This timing ensures that the medication can form an effective barrier over the ulcer before food intake and helps maximize its healing properties.