To determine which medications the nurse should hold for clarification, we need to evaluate each client's medication in light of their specific lab values:
1. Magnesium sulfate for a client with a magnesium level of 1.0 mEq/L (0.41 mmol/L)
- Magnesium sulfate is generally used to treat low levels of magnesium. A normal magnesium level ranges between 1.7 to 2.2 mEq/L. Since the magnesium level here is 1.0 mEq/L, this level is lower than the normal range, indicating the client may need magnesium supplementation. Thus, the nurse should not hold the magnesium sulfate.
2. Calcium acetate for a client with a phosphate level of 8.5 mg/dL (2.75 mmol/L)
- Calcium acetate is often used to control high levels of phosphate in the blood, especially in individuals with kidney problems. The normal range for phosphate is 2.5 to 4.5 mg/dL. The phosphate level in this case is 8.5 mg/dL, which is higher than normal. High phosphate levels indicate that calcium acetate could help in lowering the phosphate level. However, there might be other contraindications or considerations for which the nurse should seek clarification. Therefore, the nurse should hold calcium acetate for clarification.
3. Clopidogrel for a client with a platelet count of 70,000/mm³ (70 x 10⁶/L)
- Clopidogrel is an antiplatelet medication used to reduce the risk of heart disease and stroke by preventing platelets from clumping together. A normal platelet count ranges from 150,000 to 450,000/mm³. In this scenario, the platelet count is significantly low at 70,000/mm³, which increases the risk of bleeding. Therefore, the nurse should hold clopidogrel for clarification.
4. Metformin for a client with a hemoglobin A1c level of 11%
- Metformin is a common medication used to control blood sugar levels in people with type 2 diabetes. The hemoglobin A1c test measures average blood glucose over the past two to three months, and levels above 6.5% indicate diabetes. An A1c level of 11% is quite high, indicating poor control of blood glucose. While the high level is a concern, metformin is often continued to help manage high glucose levels. Unless there are other specific contraindications, the nurse should not hold metformin.
In summary, based on the given lab values and medication instructions:
- The nurse should not hold magnesium sulfate.
- The nurse should hold calcium acetate for clarification.
- The nurse should hold clopidogrel for clarification.
- The nurse should not hold metformin.
Thus, the medications to be held and clarified before administering are:
- Calcium acetate for the client with a phosphate level of 8.5 mg/dL (2.75 mmol/L).
- Clopidogrel for the client with a platelet count of 70,000/mm³ (70 x 10⁶/L).
