The client is a 54-year-old male with a history of hypertension and type 2 diabetes. He takes spironolactone 25 mg per day, metformin 500 mg twice a day, and 25 units of insulin glargine.

The nurse notifies the provider that the client is having trouble remembering to take his second dose of captopril.

Which ACE inhibitors can be given only once per day? Select all that apply

A. Serum glucose level of 120 mg/dL (6.7 mmol/L):

This glucose level is within the reference range and is not directly related to the effectiveness of sodium polystyrene sulfonate in treating hyperkalemia.

B. Serum ammonia level of 30 Mcg/dL (17.62 Mamal /dL):

Serum ammonia levels are not typically affected by sodium polystyrene sulfonate, and this value is within the reference range.

When administering sodium polystyrene sulfonate to a client with acute kidney injury (AKI), the medication is used to help lower elevated potassium levels (hyperkalemia). Therefore, the laboratory finding that indicates the medication has been effective is:

C. Serum potassium level of 3.8 mEq/L (3.8 mmol/L).

Explanation: Sodium polystyrene sulfonate is a medication used to treat hyperkalemia by exchanging sodium ions for potassium ions in the intestines, leading to the removal of excess potassium from the body through the stool. A reduction in the serum potassium level within the reference range (3.5 to 5.0 mEq/L) indicates that the medication has been effective in lowering the elevated potassium level associated with AKI.

D. Hemoglobin level of 13.5 g/dl (135 g/L):

Hemoglobin levels are unrelated to the effectiveness of sodium polystyrene sulfonate in treating hyperkalemia. This hemoglobin level is within the reference range.

A. Hold the calcitriol but administer the calcium carbonate as scheduled:

Both medications should be held in the presence of significant hypercalcemia. Administering calcium in this situation can exacerbate the elevated calcium levels.

When the nurse notes that a client with hypoparathyroidism has a total calcium level of 14 mg/dL (3.5 mmol/L), which is above the reference range (normal range for adults: 9 to 10.5 mg/dL or 2.25 to 2.62 mmol/L), the appropriate action is:

B. Hold both medications until contacting the healthcare provider.

Explanation: A total calcium level significantly above the reference range can indicate hypercalcemia, which can be a concern, especially for a client with hypoparathyroidism who may be receiving calcium supplementation and calcitriol (active vitamin D) to manage their condition. In cases of hypercalcemia, it is important to withhold calcium and vitamin D supplements and consult the healthcare provider for further evaluation and guidance. The client's calcium levels need to be rechecked, and the treatment plan may need to be adjusted.

C. Hold the calcium carbonate, but administer the calcitriol as scheduled:

Holding only one of the medications is not appropriate when the client has hypercalcemia. Both medications should be withheld pending further evaluation by the healthcare provider.

D. Administer both prescribed medications as scheduled:

Administering both medications when the client has hypercalcemia can worsen the condition and is not appropriate. Hypercalcemia requires intervention and close monitoring.