A nurse is caring for a client with a magnesium level of 3.1 mEq/L. Which medication is the most appropriate?

When managing a client with a magnesium level of 3.1 mEq/L, which indicates hypermagnesemia (elevated magnesium levels), the administration of calcium gluconate is the most appropriate choice. In cases of hypermagnesemia, calcium gluconate serves as an antidote that can help stabilize the cardiac membranes and counteract the effects of excess magnesium on the heart. Hypermagnesemia can lead to dangerous cardiovascular effects, including cardiac arrest, due to the myocardial depressant effects of high magnesium levels. Calcium acts to restore normal neuromuscular function and can help prevent or mitigate the complications associated with elevated magnesium.

Magnesium gluconate would not be appropriate in this scenario, as it is a source of magnesium and would further raise the magnesium level, exacerbating the condition. Cinacalcet, used to manage secondary hyperparathyroidism, does not address the issues related to hypermagnesemia. Regular insulin is used primarily for managing hyperglycemia and does not have a role in treating high magnesium levels. Therefore, calcium gluconate is the correct medication to use for a client with hypermagnesemia, focusing on countering its cardiovascular effects.