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 D

Explanation

A. Sodium: Monitoring sodium is important in many conditions, but diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), is more commonly associated with gastrointestinal bleeding rather than causing significant electrolyte imbalances like hyponatremia. Sodium levels are not the primary concern in this scenario.

B. Glucose: Blood glucose monitoring is critical for clients with diabetes or corticosteroid use, but diclofenac is not known to directly impact glucose metabolism. Reviewing glucose levels would not immediately address the symptoms of pallor and fatigue.

C. Total protein: Total protein levels reflect nutritional and liver status but are not the best marker for acute blood loss or anemia. Changes in total protein would not directly explain symptoms like pallor and fatigue related to NSAID complications.

D. Hemoglobin: Diclofenac can cause gastrointestinal irritation and occult bleeding, leading to anemia. Pallor and fatigue are classic symptoms of low hemoglobin levels, making it the most important laboratory value to review to evaluate for possible GI bleeding and anemia.

A. Advise the client that once symptoms occur it is too late to receive an influenza vaccination. B. Explain to the client that antibiotics are not useful in treating viral infections such as influenza. C. Refer the client to the healthcare provider at the clinic to obtain a medication prescription. D. Instruct the client that over-the-counter medications are sufficient to manage influenza symptoms.

Correct Answer is C

Explanation

A. Advise the client that once symptoms occur it is too late to receive an influenza vaccination: While it is true that vaccination is preventive and not therapeutic, the client's question concerns treatment, not vaccination. Discussing vaccination at this point does not directly address the immediate need for antiviral therapy.

B. Explain to the client that antibiotics are not useful in treating viral infections such as influenza: Although educating about antibiotic misuse is important, this response does not answer the client’s question about oseltamivir, which is an antiviral medication specifically intended for early influenza treatment.

C. Refer the client to the healthcare provider at the clinic to obtain a medication prescription: Oseltamivir must be prescribed and is most effective when started within 48 hours of symptom onset. Prompt referral ensures the client can receive the medication in time to potentially shorten the illness and reduce complications.

D. Instruct the client that over-the-counter medications are sufficient to manage influenza symptoms: Over-the-counter remedies may relieve symptoms, but they do not treat the viral infection. Early antiviral treatment with oseltamivir can decrease the severity and duration of influenza, particularly in high-risk individuals.

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