An older adult resident of a long-term care facility has been prescribed calcium citrate to address decreasing bone density. The nurse should review the resident’s medication administration record knowing that what medication may decrease the effects of calcium?

A. An increase in serum lactate – This is a critical laboratory value that can indicate lactic acidosis, a serious side effect associated with metformin, especially in older adults or those with renal impairment. An increase in serum lactate necessitates discontinuation of the medication.

B. A decrease in hemoglobin and hematocrit – While this change may indicate anemia, it is not directly associated with the need to discontinue metformin. Further evaluation of the cause of anemia would be necessary.

C. An increase in white blood cells – This could indicate an infection or inflammatory process but does not specifically necessitate the discontinuation of metformin.

D. A decrease in potassium accompanied by an increase in sodium – While electrolyte imbalances should be monitored, this change does not directly indicate that metformin should be discontinued.

Hydrocortisone is a synthetic form of the hormone cortisol, which is produced by the adrenal glands. Addison's disease is a condition in which the adrenal glands do not produce enough cortisol and other hormones. Treatment with hydrocortisone is a lifelong therapy that replaces the missing hormones.

One of the potential adverse effects of long-term treatment with hydrocortisone is the development of sodium depletion or hyponatremia. This occurs because hydrocortisone can increase the excretion of sodium in the urine, leading to low levels of sodium in the blood.

To mitigate this potential adverse effect, the nurse should encourage the client to increase their intake of sodium. This can be done through dietary sources such as adding more salt to their food or drinking sports drinks that contain electrolytes. The client should also be monitored closely for signs of sodium depletion, such as weakness, fatigue, and confusion.

It is also important to note that long-term treatment with hydrocortisone can increase the risk of other adverse effects, such as osteoporosis, hyperglycemia, and infection. The nurse should educate the client on these potential adverse effects and encourage them to follow their healthcare provider's instructions for monitoring and management.