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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Correct Answer is A

Explanation

A. Take the medication during pregnancy: Methotrexate is highly teratogenic and absolutely contraindicated during pregnancy because it can cause severe fetal malformations or death. Clients must be instructed to avoid pregnancy while on methotrexate and for some time after discontinuing the drug, making this a critical point requiring immediate correction.

B. Use folic acid to protect the liver: Methotrexate interferes with folate metabolism, and folic acid supplementation is recommended to reduce some side effects such as liver toxicity, mucositis, and bone marrow suppression. This statement reflects appropriate understanding of supportive care during methotrexate therapy.

C. Store the medication at room temperature: Methotrexate should be stored at room temperature away from light and moisture, consistent with safe medication handling practices. This information is accurate and does not require additional instruction.

D. Obtain a platelet count weekly: Methotrexate can cause bone marrow suppression, increasing the risk of thrombocytopenia. Regular monitoring of blood counts, including platelets, is standard practice to detect toxicity early, so this action is appropriate and understood correctly.

A. Assess for secondary Candida infection. B. Monitor for electrolyte imbalance. C. Administer sucralfate once a day, preferably at bedtime. D. Give sucralfate on an empty stomach.

Correct Answer is D

Explanation

A. Assess for secondary Candida infection: Sucralfate acts locally in the stomach to form a protective barrier over ulcers; it does not suppress the immune system or significantly alter the microbial flora. Therefore, it does not increase the risk of Candida infections, making this assessment unnecessary specifically for sucralfate therapy.

B. Monitor for electrolyte imbalance: Sucralfate does not typically cause major electrolyte disturbances. Unlike antacids, which may alter serum electrolytes, sucralfate's mechanism is physical coating of the gastric mucosa rather than altering gastric pH significantly or causing systemic absorption issues.

C. Administer sucralfate once a day, preferably at bedtime: Sucralfate is usually prescribed multiple times a day, typically four times daily, before meals and at bedtime. Administering it only once daily would not provide adequate mucosal protection necessary for ulcer healing.

D. Give sucralfate on an empty stomach: Sucralfate must be given on an empty stomach for optimal binding to the ulcer site. Food can interfere with its ability to adhere properly to the mucosal lining, reducing its effectiveness in promoting ulcer healing.

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