A patient diagnosed with hyperparathyroidism is being managed for hypercalcemia. Which intervention should the nurse prioritize to mitigate the risk of complications associated with this condition?

Rationale:

A. Clients with a history of substance use disorder are at risk for undertreatment of pain due to provider or nurse concerns about dependence. Pain management should be based on clinical assessment and patient-reported pain, using prescribed analgesics while closely monitoring for efficacy, side effects, and potential misuse. This approach ensures adequate pain relief without stigmatization or undertreatment.

B. Withholding pain medication based solely on a history of substance use is unethical and unsafe. It can lead to unnecessary suffering, withdrawal, or escalation of pain-related stress, and does not address the immediate need for pain relief. Psychiatric evaluation may be helpful for comorbid conditions, but it does not replace pain management.

C. This is unsafe because it discourages honest communication, may result in inadequate analgesia, and does not reduce risk of dependence in a controlled, clinically monitored setting. Pain should always be assessed and treated objectively.

D. Non-pharmacological strategies (e.g., heat, relaxation, physical therapy) can be adjuncts but are not sufficient for moderate to severe pain. Complete reliance on these methods may result in untreated pain and unnecessary suffering.

Rationale:
A. Older adults (≥65 years) have decreased immune function and reduced respiratory muscle strength. In myasthenia gravis, weakened respiratory muscles further increase the risk of ineffective airway clearance and pneumonia.

B. Clients with asthma have compromised airway function, and clients with AIDS are immunocompromised. Both conditions significantly increase susceptibility to respiratory infections, including pneumonia, especially when combined with myasthenia gravis.

C. Vaccination against pneumococcus and influenza is protective, not a risk factor. It reduces the likelihood of developing pneumonia, making this option incorrect.

D. Local anesthesia does not significantly depress respiratory function or airway protective reflexes compared to general anesthesia. Therefore, it does not substantially increase pneumonia risk in this context.

E. Mechanical ventilation is a major risk factor for ventilator-associated pneumonia (VAP). Additionally, a closed head injury may impair cough and gag reflexes, increasing aspiration risk.

F. Dysphagia (difficulty swallowing) greatly increases the risk of aspiration, which can lead to aspiration pneumonia. This is especially significant in myasthenia gravis due to bulbar muscle weakness.