The nurse is preparing to administer alendronate to a client with osteoporosis. Which laboratory value indicates that the nurse should withhold the medication and contact the healthcare provider?

Reference Range:

Total Calcium (9 to 10.5 mg/dL (2.3 to 2.6 mmol/L)]

Sodium [136 to 145 mEq/L (136 to 145 mmol/L)]

Potassium [3.5 to 5 mEq/L (3.5 to 5 mmol/L)]

Magnesium [1.3 to 2.1 mEq/L (0.65 to 1.05 mmol/L)]

Calcium 13.0 mg/dL (3.3 mmol/L).

Magnesium 2.4 mEq/L (2.4 mmol/L).

Potassium 5.2 mEq/L (5.2 mmol/L).

Sodium 132 mEq/L (132 mmol/L)

Answer and Explanation

The Correct Answer is A

A. Calcium 13.0 mg/dL (3.3 mmol/L): Alendronate is used to inhibit bone resorption and is typically prescribed when calcium levels are normal. A high calcium level suggests hypercalcemia, which could worsen if alendronate is given. Therefore, the medication should be withheld, and the healthcare provider must be notified for further evaluation.

B. Magnesium 2.4 mEq/L (2.4 mmol/L): This magnesium level is slightly elevated but is not critically abnormal. Magnesium levels are not a primary consideration when deciding whether to administer alendronate, and this finding alone would not necessitate withholding the medication.

C. Potassium 5.2 mEq/L (5.2 mmol/L): Mild hyperkalemia is noted here, but potassium levels do not directly impact the safety or effectiveness of alendronate. The nurse should monitor it but does not need to withhold alendronate based on this finding.

D. Sodium 132 mEq/L (132 mmol/L): This value indicates mild hyponatremia, but sodium abnormalities are not a direct contraindication to alendronate therapy. The medication could still be administered while addressing the sodium imbalance separately.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. Notify the healthcare provider if anorexia occurs: Anorexia can be a side effect of exenatide, but it is generally mild and often transient. While persistent or severe anorexia should be reported, it is not the most immediate or dangerous concern compared to the risk of hypoglycemia when combining exenatide with a sulfonylurea like glimepiride.

B. Consume additional sources of potassium: Exenatide is not known to cause significant potassium depletion. Hypokalemia is not a common complication with either exenatide or glimepiride therapy, so there is no specific need to focus on increasing potassium intake.

C. Watch for signs of jitteriness or diaphoresis: Combining exenatide with glimepiride significantly increases the risk of hypoglycemia. Symptoms like jitteriness, diaphoresis, shakiness, and confusion are hallmark signs of low blood sugar, making it crucial to educate the client to recognize and manage hypoglycemia promptly.

D. Administer subcutaneously after meals: Exenatide should be administered subcutaneously, but it must be given before meals, typically within 60 minutes prior to eating. Administering it after meals would decrease its effectiveness in controlling postprandial blood glucose spikes.

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies. B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses. C. Begin the infusion and submit a drug reaction report to the nursing supervisor. D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests.

Correct Answer is A

Explanation

A. Hold the dose and notify the healthcare provider (HCP) of the changes in the laboratory studies: Fluconazole is hepatotoxic and can cause elevations in liver enzymes, including AST. A rising trend in liver enzymes suggests possible liver injury, and administering another dose without medical clearance could worsen hepatic damage. Immediate communication with the HCP is the safest and most appropriate action.

B. Hold the dose and notify the pharmacy to stop dispersing the next premixed doses: Although stopping further dispensing may eventually be needed if the drug is discontinued, the pharmacy cannot make this clinical decision. Notifying the HCP for evaluation and new orders must take priority.

C. Begin the infusion and submit a drug reaction report to the nursing supervisor: Initiating the infusion despite abnormal liver function tests can endanger the client. Reporting an adverse reaction to the supervisor is important after ensuring the client’s safety, but the infusion should be held first pending provider instructions.

D. Begin the infusion and monitor the client's blood urea nitrogen (BUN), serum creatinine, and liver function tests: While monitoring labs is critical during fluconazole therapy, starting the infusion in the presence of worsening liver enzyme trends without provider approval can increase the risk of serious hepatic complications.

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