The nurse is educating an adult client who has been diagnosed with adrenocortical carcinoma about the prescribed mitotane 6 g P0 in divided doses. Which statement made by the client establishes the need for further clarification? a. "If I have a trauma or go into shock, the drug is temporarily stopped."

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.

Calcitonin is a medication used to treat postmenopausal osteoporosis in older adults. It works by inhibiting bone resorption and decreasing the breakdown of bone tissue. Calcitonin is available in several forms, including intranasal spray, subcutaneous injection, and intravenous infusion. However, for the treatment of postmenopausal osteoporosis, calcitonin is most commonly administered via intranasal spray.

Intranasal calcitonin is easy to use and well-tolerated by most clients. It is absorbed through the nasal mucosa and reaches peak blood levels within 30-60 minutes after administration. The medication is usually administered once daily, alternating nostrils with each dose.

Other routes of administration, such as subcutaneous injection and intravenous infusion, may be used in certain situations, such as for the treatment of Paget's disease of bone or hypercalcemia. However, these routes of administration are less commonly used for the treatment of postmenopausal osteoporosis in older adults. The healthcare provider will determine the appropriate route of administration based on the individual client's needs and medical history.