Prior to administering oral doses of calcitriol and calcium carbonate to a client with hypoparathyroidism, the nurse notes that the client's total calcium level is 14 mg/dL (3.5 mmol/L). Which action should the nurse implement?Reference Range:Calcium [8.5 to 10.5 mg/dL (2.25 to 2.75 mmol/L]
Explanation & Rationale
A. Hold both medications until contacting the healthcare provider (HCP): A total calcium level of 14 mg/dL is critically high and indicates hypercalcemia. Continuing calcitriol or calcium carbonate could worsen the hypercalcemia, so both medications should be held and the HCP contacted immediately for further orders.B. Hold the calcitriol, but administer the calcium carbonate as scheduled: Calcium carbonate increases serum calcium levels, and administering it would exacerbate the already dangerously high calcium level. It should not be given until the situation is reassessed.C. Hold the calcium carbonate, but administer the calcitriol as scheduled: Calcitriol promotes intestinal absorption of calcium, which could further elevate serum calcium levels. Giving calcitriol would be unsafe until the client’s calcium status is re-evaluated.D. Administer both prescribed medications as scheduled: Administering both medications would significantly increase the risk of severe hypercalcemia complications, such as cardiac arrhythmias or neurologic changes, and must be avoided until new instructions are received.