A patient with hyperparathyroidism is being evaluated for treatment options. Which of the following findings would most likely be present in this patient related to calcium metabolism?

Rationale:
A. Opioids like fentanyl are not typically associated with increased urination or incontinence. In fact, they may cause urinary retention rather than increased output. Therefore, this is incorrect.

B. Fentanyl is a potent opioid analgesic that can significantly depress the central nervous system, particularly the respiratory center in the brain. High doses increase the risk of respiratory depression, which can lead to hypoventilation, hypoxia, and potentially death if not promptly recognized and managed. This is the most critical adverse effect to monitor, making this the correct answer.

C. Opioids generally do not cause increased heart rate; they are more likely to cause bradycardia due to their depressant effects on the central nervous system. Therefore, this is incorrect.

D. Fentanyl is more commonly associated with hypotension rather than elevated blood pressure due to vasodilation and decreased sympathetic tone. Therefore, this option is incorrect.

Rationale:

A. Gastrointestinal distress caused by NSAIDs like ketorolac is primarily due to gastric mucosal irritation, not potassium deficiency. A diet high in potassium does not prevent NSAID-related GI complications. Protective strategies include taking the medication with food or using gastroprotective agents if needed.

B. Ketorolac is a potent NSAID with a high risk of renal toxicity, gastrointestinal bleeding, and cardiovascular effects. It is generally not recommended for long-term or repeated use, and overlapping NSAIDs can increase the risk of adverse effects. The nurse should avoid concurrent NSAIDs unless explicitly prescribed.

C. Ketorolac can cause acute kidney injury, fluid retention, and electrolyte imbalances, even in patients without prior renal issues. Monitoring serum creatinine, BUN, and intake/output is essential to detect early renal compromise. This is especially important in patients with rheumatoid arthritis who may already be at risk due to chronic inflammation or other medications.

D. Taking ketorolac on an empty stomach increases the risk of gastric irritation and ulcers. NSAIDs should typically be taken with food or milk to minimize gastrointestinal adverse effects.