A nurse is caring for a client who is taking lovastatin and has a new prescription for ezetimibe to lower cholesterol levels.
Which of the following laboratory values should the nurse monitor?

Choice A rationale

Alendronate is a bisphosphonate medication used to treat osteoporosis. It is known to be highly irritating to the esophageal mucosa, and if it lodges in the esophagus, it can cause severe esophagitis, ulceration, or erosion. Assessing the client's ability to swallow ensures safe passage of the medication and minimizes the risk of esophageal injury, highlighting a critical safety measure.

Choice B rationale

Alendronate should not be administered before bed. For optimal absorption and to minimize the risk of esophageal irritation, alendronate must be taken in the morning upon waking, at least 30 minutes before the first food, beverage, or medication. Taking it before bed increases the likelihood of the pill lingering in the esophagus, leading to irritation and potential injury.

Choice C rationale

Alendronate should not be administered with orange juice. The absorption of alendronate is significantly impaired by food, beverages other than plain water, and certain minerals like calcium. Orange juice contains calcium and can decrease the bioavailability of the medication, thereby reducing its therapeutic effectiveness. It must be taken with plain water only.

Choice D rationale

Informing the client to remain supine after taking the medication is incorrect. To facilitate rapid transit to the stomach and minimize esophageal contact, clients must remain upright (sitting or standing) for at least 30 minutes after taking alendronate, and until after their first food of the day. Lying down increases the risk of esophageal reflux and irritation.

Choice A rationale

Sodium bicarbonate is used to treat metabolic acidosis or certain drug overdoses, but it does not directly address hypocalcemia, which is the underlying cause of a positive Trousseau's sign. Its primary action is to increase systemic pH, not calcium levels.

Choice B rationale

Magnesium sulfate is administered for magnesium deficiencies, pre-eclampsia, or certain arrhythmias. While magnesium deficiency can sometimes exacerbate hypocalcemia, it is not the primary treatment for Trousseau's sign, which specifically indicates low calcium.

Choice C rationale

Calcium gluconate is the appropriate medication to administer for a positive Trousseau's sign, as this sign indicates hypocalcemia (low serum calcium levels). Calcium gluconate directly replenishes calcium, correcting the neuromuscular excitability caused by insufficient extracellular calcium.

Choice D rationale

Potassium chloride is given to treat hypokalemia (low potassium levels). While electrolyte imbalances can be complex, a positive Trousseau's sign is specifically indicative of hypocalcemia, not hypokalemia, and potassium administration would not resolve the underlying issue.