An older adult client with pernicious anemia has been receiving daily injections of cyanocobalamin for two weeks and reports that the injections are painful. The nurse notes that the client's hematocrit is 43% (0.43 volume fraction). Which action should the nurse implement?

Reference Range:

Hematocrit (Hct) [37% to 47% (0.37 to 0.47 volume fraction)]

Instruct the client that since the hematocrit remains low, the daily injections are still necessary.

Notify the healthcare provider of the patient's hematocrit level so the frequency of injections can be reduced.

Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition.

Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections.

Answer and Explanation

The Correct Answer is D

A. Instruct the client that since the hematocrit remains low, the daily injections are still necessary: A hematocrit of 43% is within the normal range, suggesting the client’s anemia is improving. If the hematocrit were still low, continuing daily injections would be appropriate, but this is not the case here.

B. Notify the healthcare provider of the client’s hematocrit level so the frequency of injections can be reduced: Since the hematocrit is normal, there is no need to notify the healthcare provider specifically for changing the injection frequency based solely on the hematocrit level. Reducing injection frequency should be based on the overall treatment plan and not just the current hematocrit.
C. Advise the client that the medication is having the desired effect, but daily injections will continue to be needed for life for this chronic condition: While the medication may be effective, informing the client about the potential for less frequent injections could improve adherence and reduce discomfort, if the healthcare provider approves.
D. Offer to instruct the client in self-administration techniques to improve the client's sense of control over the painful daily injections: Teaching self-administration can empower the client and potentially reduce discomfort by allowing the client to become more comfortable with the process. It also offers the opportunity for the client to manage their injections more conveniently and with greater control.

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Correct Answer is A

Explanation

A. Phosphate: Calcium acetate is used primarily to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gut, preventing its absorption, which helps lower phosphate levels in the blood. A decrease in phosphate levels indicates that the calcium acetate is effectively controlling phosphate levels.
B. pH: While maintaining normal pH levels is important in CKD, calcium acetate does not directly affect blood pH. The primary role of calcium acetate is to manage phosphate levels rather than pH balance.
C. Calcium: Calcium acetate is a phosphate binder and does not primarily target calcium levels. It can influence calcium levels indirectly, but a decrease in calcium is not the direct measure of the medication's effectiveness. Instead, monitoring phosphate levels is more indicative of the medication’s effectiveness.
D. Potassium: Calcium acetate does not have a direct effect on potassium levels. It is specifically used to manage phosphate levels in CKD patients. Changes in potassium levels would not indicate the effectiveness of calcium acetate.

A. Diabetes mellitus. B. Deep vein thrombosis. C. Renal disease. D. Chronic bronchitis.

Correct Answer is C

Explanation

A. Diabetes mellitus: While diabetes mellitus is an important condition to consider for overall health, it is not directly related to the use of magnesium hydroxide and aluminum hydroxide, as these antacids primarily affect the gastrointestinal system and renal function.
B. Deep vein thrombosis: Deep vein thrombosis is related to blood clot formation and does not have a direct connection to the use of magnesium and aluminum hydroxide, which affect the gastrointestinal system and renal function.
C. Renal disease: Magnesium hydroxide and aluminum hydroxide can affect kidney function and cause complications in individuals with renal disease. Magnesium and aluminum are excreted through the kidneys, and impaired renal function can lead to an accumulation of these substances, causing potential toxicity.
D. Chronic bronchitis: Chronic bronchitis affects the respiratory system and is not directly impacted by the use of magnesium and aluminum hydroxide, which are primarily concerned with gastrointestinal and renal function.

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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?

Correct Answer is A

Explanation

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Correct Answer is C

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