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 C

Explanation

A) Assessing for orthostatic hypotension is important when administering medications that can lower blood pressure, but in this scenario, the vital signs indicate bradycardia (heart rate of 48 beats/minute), which may be a contraindication for administering labetalol. Therefore, withholding the dose and notifying the healthcare provider is the priority.

B) Administering the dose and monitoring the client's blood pressure regularly could potentially worsen bradycardia and hypotension, especially given the client's current vital signs. It is safer to withhold the dose and seek guidance from the healthcare provider.

C) Withholding the scheduled dose and notifying the healthcare provider is the most appropriate action in this situation. The client's bradycardia, along with the hypertension, raises concern about the safety of administering labetalol without further assessment and possible adjustment of the treatment plan.

D) Applying a telemetry monitor may be warranted if the client's bradycardia is of concern, but it does not address the potential risk associated with administering labetalol to a client with a heart rate of 48 beats/minute. The priority is to withhold the medication and inform the healthcare provider for further evaluation and guidance.

A. Begin cardioversion to stabilize heart rhythm. B. Give digoxin by another route to slow absorption. C. Administer potassium to stabilize the heart rate. D. Check acid-base and electrolyte values.

Correct Answer is D

Explanation

Begin cardioversion to stabilize heart rhythm: Cardioversion is not the appropriate intervention for digoxin toxicity. Digoxin toxicity can cause arrhythmias, but the initial action should be to assess and manage the underlying cause, rather than immediately proceeding to cardioversion.

B) Give digoxin by another route to slow absorption: Slowing the absorption of digoxin is not the appropriate action for treating digoxin toxicity. Instead, the focus should be on managing the existing toxicity and preventing further absorption by withholding additional doses.

C) Administer potassium to stabilize the heart rate: While potassium may be indicated as part of the treatment for digoxin toxicity, particularly if hypokalemia is contributing to the toxicity, it is not the initial action. The priority is to assess the client’s acid-base and electrolyte values to identify any abnormalities contributing to the toxicity.

D) Check acid-base and electrolyte values: This is the correct action. Digoxin toxicity can be exacerbated by electrolyte imbalances, particularly hypokalemia, hypercalcemia, and hypomagnesemia. Therefore, assessing the client’s acid-base and electrolyte values is essential to identify and correct any abnormalities contributing to the toxicity. Once identified, appropriate interventions can be implemented to manage the toxicity and stabilize the client’s condition.

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

The nurse is reviewing the client’s laboratory results. Based on a client’s serum digoxin level, the client is diagnosed with digoxin toxicity. Which action should the nurse expect to implement?

Correct Answer is D

Explanation

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