A client is receiving miotics for the treatment of open-angle glaucoma. The nurse determines that a priority nursing problem is a “Risk for injury and this is based on which etiology?

A) A total calcium level of 5.5 mg/dL (1.4 mmol/L) is critically low, as the normal reference range for total calcium is between 9 to 10.4 mg/dL (2.3 to 2.6 mmol/L). Hypocalcemia can lead to serious complications such as tetany, arrhythmias, and seizures. Before administering methylprednisolone, which can further decrease calcium levels and contribute to osteoporosis, it is essential to notify the healthcare provider to address the client's low calcium level. This may involve correcting the calcium deficiency before proceeding with the administration of the

B) If a healthcare provider orders a calcium supplement for the client, administering it would be appropriate to help correct the hypocalcemia before administering methylprednisolone. However, in the absence of a direct order, the nurse should first notify the healthcare provider to ensure that the client's calcium levels are addressed appropriately before proceeding with any medication that could exacerbate the issue. The priority is to manage the low calcium levels before administering corticosteroids like methylprednisolone.

C) Administering methylprednisolone with a glass of milk may help with calcium absorption; however, this does not directly address the critical issue of hypocalcemia. The nurse must first prioritize notifying the healthcare provider and correcting the calcium imbalance before proceeding with medication administration.

D) Tapering the dose of methylprednisolone is not immediately appropriate based on the low calcium level alone. Methylprednisolone is often tapered to avoid withdrawal symptoms, but the nurse's first priority is to address the client's hypocalcemia, which can have more immediate clinical consequences. The focus should be on stabilizing the calcium level first.

A) A serum creatinine level of 1.0 mg/dL falls within the reference range (0.5 to 1.1 mg/dL) and does not indicate immediate action by the nurse. Creatinine levels within the reference range suggest normal kidney function.

B) A platelet count of 100,000/mm3 (100 x 10^9/L) is below the lower limit of the reference range (150,000 to 400,000/mm3). Thrombocytopenia, or low platelet count, increases the risk of bleeding complications, especially when administering anticoagulants like enoxaparin. Therefore, a platelet count of 100,000/mm3 requires immediate action by the nurse to assess for bleeding and notify the healthcare provider.

C) A hematocrit of 45% (0.45 volume fraction) falls within the reference range (42% to 52%) and does not indicate immediate action by the nurse.

D) A blood urea nitrogen (BUN) level of 20 mg/dL (7.1 mmol/L) falls within the reference range (10 to 20 mg/dl) and does not indicate immediate action by the nurse.