Prior to administering an oral dose of methylprednisolone, the nurse determines the client's serum total calcium level is 5.5 mg/dl (1.4 mmol/L). Which action is most important for the nurse to take?

Reference Range:

Total Calcium 9 to 10.4 mg/dL (2.3 to 2.6 mmol/L)
A. Notify the healthcare provider immediately

B.Administer a calcium supplement as ordered by the healthcare provider

C. Administer the medication with a glass of milk.

D. Begin tapering the drug dose per protocol.

Notify the healthcare provider immediately

Administer a calcium supplement as ordered by the healthcare provider

Administer the medication with a glass of milk.

Begin tapering the drug dose per protocol.

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is D

Explanation

A) Holding the dose of IV pantoprazole until the client has finished eating breakfast may delay the onset of action of the medication, as pantoprazole is typically administered before meals to maximize its effectiveness in reducing gastric acid secretion. Additionally, delaying the dose may not provide immediate relief for the client's he’rtburn symptoms.

B) Providing a PRN dose of antacid along with the scheduled medications may temporarily relieve the client's he’rtburn symptoms, but it does not address the underlying cause of peptic ulcer disease or prevent further gastric acid secretion, which is the primary goal of pantoprazole and sucralfate administration.

C) Instructing the client to take the dose of sucralfate PO while eating breakfast may interfere with the optimal absorption of the medication. Sucralfate forms a protective barrier over ulcers in the stomach and should be administered on an empty stomach to allow it to adhere to the gastric mucosa effectively.

D) Administering both of the medications before breakfast as scheduled is the most appropriate action. Pantoprazole is a proton pump inhibitor that reduces gastric acid production, and sucralfate forms a protective barrier over ulcers in the stomach. Administering these medications before breakfast allows them to work synergistically to reduce gastric acid secretion and protect the gastric mucosa, helping to alleviate the client's he’rtburn symptoms and promote ulcer healing.

A. Sensitivity to the sun can develop. B. Hard candy can be used for a dry mouth. C. Insomnia may occur while taking the medication. D. Another form of contraception is not needed.

Correct Answer is D

Explanation

A) Sensitivity to the sun can develop: St. John's wo’t can increase photosensitivity, making the skin more prone to sunburn. Therefore, clients should be advised to use sunscreen and protective clothing when exposed to sunlight.

B) Hard candy can be used for a dry mouth: Dry mouth is a common side effect of St. John's wo’t. Suggesting the use of hard candy can help alleviate the discomfort associated with dry mouth by stimulating saliva production.

C) Insomnia may occur while taking the medication: St. John's wo’t may cause insomnia or exacerbate existing sleep disturbances. Clients should be informed about this potential side effect so they can monitor their sleep patterns and seek appropriate management if needed.

D) Another form of contraception is not needed: This statement requires further instruction. St. John's wo’t can decrease the effectiveness of hormonal contraceptives, including birth control pills, patches, and rings. Therefore, clients using hormonal contraceptives should be advised to use additional or alternative methods of contraception to prevent unintended pregnancy.

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Naxlex Comprehensive Predictor Exams

A client with peptic ulcer disease (PUD) is scheduled to receive doses of pantoprazole IV and sucralfate PO before breakfast at 0730. The client reports experiencing heartburn when the nurse brings the scheduled medications. Which action should the nurse take?

Correct Answer is D

Explanation

A female client with mild depression reports to the nurse of recently starting St. John's wo’t. Which information provided by the client requires further instruction?

Correct Answer is D

Explanation

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