Report bradycardia or hypotension during infusion; give slowly.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with hyperkalemia and ECG changes is to receive IV calcium gluconate. The nurse understands the purpose of this medication is to:
Answer: A. Calcium gluconate does not lower potassium; it stabilizes the cardiac cell membrane to protect the heart from dangerous dysrhythmias while other therapies lower the potassium level.
Question 2 of 5
A client with a serum calcium of 7.2 mg/dL is prescribed calcium gluconate. Which assessment finding supports this diagnosis of hypocalcemia?
Answer: A. Hypocalcemia (normal 9.0 to 10.5 mg/dL) increases neuromuscular excitability, producing a positive Chvostek sign, a positive Trousseau sign, tetany, tingling, and muscle cramps. Decreased deep tendon reflexes, a positive only in hypercalcemia, and flank pain from stones reflect hypercalcemia, not hypocalcemia.
Question 3 of 5
The nurse is teaching a client with CKD about taking calcium acetate (PhosLo). When should the client take this medication?
Answer: A. Calcium acetate is a phosphate binder. It must be taken WITH meals so it binds dietary phosphate in the GI tract and prevents its absorption. Taking it between meals or on an empty stomach defeats its purpose. It is not taken at bedtime apart from food.
Question 4 of 5
A client with hypercalcemia is being treated. Which nursing intervention is appropriate?
Answer: A. Encouraging fluids and promoting mobility help lower calcium by diluting it and reducing bone resorption; isotonic IV fluids and loop diuretics like furosemide also enhance calcium excretion. Restricting fluids, encouraging dairy-rich diets, or promoting bed rest would worsen hypercalcemia. Increasing fluid intake is the correct action.
Question 5 of 5
A client with chronic kidney disease takes calcium acetate with meals. The nurse should instruct the client that this medication works best when taken:
Answer: A. Calcium acetate is a phosphate binder and must be taken with meals so it can bind dietary phosphate in the gut. Taking it between meals or at bedtime on an empty stomach reduces its phosphate-binding effect.
Keep the streak going with more questions like these, each with a full rationale.
What is calcium gluconate?
Calcium is vital for cardiac, neuromuscular, and clotting function. Key principle: give IV calcium slowly, and it is the antidote for magnesium toxicity and cardiac membrane protection in hyperkalemia.
Key points to remember
- It is the antidote for magnesium sulfate toxicity.
- In hyperkalemia it stabilizes the cardiac membrane but does not lower the potassium level.
- It treats acute hypocalcemia, which causes tetany, Chvostek and Trousseau signs, and seizures.
- IV calcium is given slowly because rapid administration causes bradycardia and hypotension.
- It is incompatible with sodium bicarbonate and many phosphate solutions, which form precipitates.
Nursing priorities
- Administer IV calcium slowly with cardiac monitoring.
- Monitor for hypocalcemia signs: Chvostek sign, Trousseau sign, tetany, and tingling.
- Use as ordered for magnesium toxicity and hyperkalemia with ECG changes.
- Assess the IV site closely; extravasation causes severe tissue damage.
- Check serum calcium and monitor heart rhythm during infusion.
Labs & values
Patient teaching
- Report numbness or tingling around the mouth or in the fingers.
- Frequent heart monitoring is expected during the infusion.
- Report any pain or swelling at the IV site.
Red flags: report now
- Report bradycardia or hypotension during infusion; give slowly.
- Never mix in the same line as sodium bicarbonate (precipitate forms).
- Report IV infiltration immediately (tissue necrosis).
References
Clinical references for this topic
