A client with chronic kidney disease (CKD) is receiving calcium acetate 667 mg PO. A decrease in which blood value indicates to the nurse that the medication is having the desired effect?

A) A total calcium level of 5.5 mg/dL (1.4 mmol/L) is critically low, as the normal reference range for total calcium is between 9 to 10.4 mg/dL (2.3 to 2.6 mmol/L). Hypocalcemia can lead to serious complications such as tetany, arrhythmias, and seizures. Before administering methylprednisolone, which can further decrease calcium levels and contribute to osteoporosis, it is essential to notify the healthcare provider to address the client's low calcium level. This may involve correcting the calcium deficiency before proceeding with the administration of the

B) If a healthcare provider orders a calcium supplement for the client, administering it would be appropriate to help correct the hypocalcemia before administering methylprednisolone. However, in the absence of a direct order, the nurse should first notify the healthcare provider to ensure that the client's calcium levels are addressed appropriately before proceeding with any medication that could exacerbate the issue. The priority is to manage the low calcium levels before administering corticosteroids like methylprednisolone.

C) Administering methylprednisolone with a glass of milk may help with calcium absorption; however, this does not directly address the critical issue of hypocalcemia. The nurse must first prioritize notifying the healthcare provider and correcting the calcium imbalance before proceeding with medication administration.

D) Tapering the dose of methylprednisolone is not immediately appropriate based on the low calcium level alone. Methylprednisolone is often tapered to avoid withdrawal symptoms, but the nurse's first priority is to address the client's hypocalcemia, which can have more immediate clinical consequences. The focus should be on stabilizing the calcium level first.

A) Notify the healthcare provider of the passage of black stools: This is the correct response. Black stools can indicate gastrointestinal bleeding, which is a serious adverse effect of NSAID use. It's im’ortant for the client to report this symptom promptly to the healthcare provider for further evaluation and management.

B) Call the clinic if diarrhea or headache occur when taking esomeprazole: While it's im’ortant to report any adverse effects of medication to the healthcare provider, diarrhea and headache are not specific to esomeprazole and may not warrant immediate attention unless severe or persistent.

C) Once pain subsides, NSAID therapy can be resumed: This statement is incorrect. The client should avoid NSAIDs in the future, as they are likely the cause of the gastric pain and gastrointestinal bleeding. Resuming NSAID therapy would increase the risk of recurrent bleeding.

D) Resume a diet that consists of milk, cream, and bland foods: This statement is incorrect. While bland foods may be easier to tolerate during acute gastric pain, they do not address the underlying issue of gastrointestinal bleeding. Additionally, dairy products like milk and cream may exacerbate symptoms in some individuals.