A 55-year-old female presents with symptoms of fatigue, muscle weakness, and depression. Laboratory results reveal elevated calcium levels and increased parathyroid hormone (PTH) levels. Which of the following is the most likely cause of her hyperparathyroidism?
Adenoma of the parathyroid gland.
Thyroid carcinoma.
Vitamin D deficiency.
Chronic kidney disease.
The Correct Answer is A
Choice A Reason:
An adenoma of the parathyroid gland is the most common cause of primary hyperparathyroidism. This benign tumor leads to the overproduction of parathyroid hormone (PTH), which in turn causes elevated calcium levels in the blood. The excessive PTH secretion disrupts the normal calcium balance, leading to symptoms such as fatigue, muscle weakness, and depression. Parathyroid adenomas account for approximately 80% of primary hyperparathyroidism cases.
Choice B Reason:
Thyroid carcinoma is a type of cancer that originates in the thyroid gland, not the parathyroid glands. While thyroid carcinoma can cause various symptoms, it does not typically lead to elevated PTH levels or hyperparathyroidism. Therefore, it is not the most likely cause of the patient’s condition.
Choice C Reason:
Vitamin D deficiency can lead to secondary hyperparathyroidism, where low levels of vitamin D cause decreased calcium absorption, prompting the parathyroid glands to produce more PTH to maintain calcium levels. However, this condition is usually associated with low or normal calcium levels, not elevated calcium levels as seen in this patient. Therefore, it is not the most likely cause of her hyperparathyroidism.
Choice D Reason:
Chronic kidney disease (CKD) can also cause secondary hyperparathyroidism due to impaired kidney function, which affects calcium and phosphate balance and vitamin D metabolism. However, similar to vitamin D deficiency, CKD-related hyperparathyroidism typically presents with low or normal calcium levels rather than elevated levels. Thus, it is not the most likely cause in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Administering intravenous fluids and pain management is the most appropriate initial intervention for a patient with sickle cell anemia presenting with severe pain, fever, and dehydration. Sickle cell crises often lead to severe pain due to vaso-occlusion, where sickled red blood cells block blood flow to various parts of the body. Intravenous fluids help to rehydrate the patient and reduce blood viscosity, which can alleviate the vaso-occlusive crisis. Pain management is crucial to provide relief and improve the patient’s comfort. This approach addresses the immediate symptoms and stabilizes the patient.
Choice B Reason:
Applying cold compresses to the painful areas is not recommended for patients with sickle cell anemia. Cold can cause vasoconstriction, which may worsen the vaso-occlusion and increase pain. Instead, warm compresses are often suggested to help dilate blood vessels and improve blood flow.
Choice C Reason:
Administering antibiotics immediately is not the primary intervention unless there is a clear indication of an infection. While fever can be a sign of infection, it can also occur due to the inflammatory response associated with a sickle cell crisis. The priority is to manage pain and dehydration first, and then evaluate the need for antibiotics based on clinical findings.
Choice D Reason:
Encouraging the patient to perform light exercise is not appropriate during an acute sickle cell crisis. Physical activity can increase oxygen demand and exacerbate the pain and vaso-occlusion. Rest and adequate hydration are more suitable to manage the crisis effectively.
Correct Answer is B
Explanation
Choice A Reason:
NPH insulin is an intermediate-acting insulin that typically has a duration of action of about 12 to 16 hours. The peak action, however, occurs much earlier, making 18-24 hours after administration an incorrect choice for the peak time of hypoglycemia risk.
Choice B Reason:
NPH insulin generally peaks 4 to 12 hours after administration This is the period when the insulin is most effective at lowering blood glucose levels, and therefore, the time when the patient is at the highest risk for hypoglycemia. Monitoring for signs of hypoglycemia during this window is crucial to ensure patient safety.
Choice C Reason:
While NPH insulin can have effects lasting up to 16 hours, the peak action occurs earlier, between 4 to 12 hours. Therefore, 12-18 hours after administration is not the correct time frame for the peak action of NPH insulin.
Choice D Reason:
NPH insulin starts to act within 1 to 2 hours after administration, but this is not the peak time. The peak action, when the risk of hypoglycemia is highest, occurs later, between 4 to 12 hours after administration.
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