The nurse is caring for a patient with hyperparathyroidism.
Upon assessment, the nurse notes polyuria, polydipsia, nausea, and vomiting and the following lab values: Potassium: 130 mg/dL. Calcium: 4.7 mg/dL. Phosphorus: 13.1 mg/dL. Magnesium: 25 mg/dL. Which of the following medications is recommended for this patient?

Regular insulin 10 units subcutaneous.

Chlorothiazide 750 mg intravenous.

Calcitonin 300 international units subcutaneous.

Calcitriol 0.75 mcg orally.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Regular insulin 10 units subcutaneous is used to lower blood glucose levels in hyperkalemia. While insulin can help shift potassium into cells, it is not indicated for hypercalcemia or hyperparathyroidism. Regular insulin would not address the elevated calcium levels in this patient.

Choice B rationale

Chlorothiazide 750 mg intravenous is a diuretic that can increase calcium reabsorption in the kidneys, potentially worsening hypercalcemia. It is contraindicated in hyperparathyroidism because it can exacerbate the high calcium levels and associated symptoms.

Choice C rationale

Calcitonin 300 international units subcutaneous is the correct choice for this patient. Calcitonin inhibits osteoclast activity, reducing bone resorption and lowering serum calcium levels. It provides rapid but short-term control of hypercalcemia, which is crucial for managing acute symptoms of hyperparathyroidism.

Choice D rationale

Calcitriol 0.75 mcg orally is an active form of vitamin D that increases calcium absorption in the gut. It is used to manage hypocalcemia, not hypercalcemia. Administering calcitriol would further elevate the already high calcium levels, worsening the patient's condition.

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Correct Answer is A

Explanation

Choice A rationale

For a client with severe malnutrition, immediate intervention is necessary to address nutritional deficiencies. Inserting a nasogastric tube and beginning enteral feeding is the first step to provide essential nutrients, stabilize the patient's condition, and prevent further complications from malnutrition.

Choice B rationale

Teaching the patient to increase protein intake and to eat more frequently is important but not the immediate priority in a case of severe malnutrition. This can be addressed after initial stabilization and nutritional support.

Choice C rationale

Total parenteral nutrition (TPN) is an option for patients who cannot tolerate enteral feeding, but initiating strict NPO status without first attempting enteral feeding is not the best initial approach. Enteral feeding is generally preferred if the gastrointestinal tract is functional.

Choice D rationale

Rinsing the mouth with alcohol-based mouthwash before meals is not a priority in managing severe malnutrition. It does not address the immediate need for nutritional support and could be harmful if ingested.

A. Refer the patient to the psychiatrist for anti-depressant medications. B. Provide portable oxygen therapy via nasal cannula during physical activity. C. Instruct the patient to increase their oral iron supplement dose until fatigue subsides. D. Encourage the patient to perform light exercises daily.

Correct Answer is B

Explanation

Choice A rationale

Referring the patient to a psychiatrist for anti-depressant medications may not address the immediate issue of fatigue and breathlessness related to acute leukemia. While psychological support is important, the primary focus should be on managing the patient's physical symptoms and improving oxygenation during activities.

Choice B rationale

Providing portable oxygen therapy via nasal cannula during physical activity is the best intervention for this patient. Oxygen therapy can help alleviate the patient's symptoms of breathlessness and fatigue by ensuring adequate oxygen levels during physical exertion. This intervention allows the patient to engage in activities with less discomfort and prevents further complications related to hypoxia.

Choice C rationale

Instructing the patient to increase their oral iron supplement dose until fatigue subsides is not appropriate without medical supervision. Iron supplementation should be based on the patient's iron levels and hematologic status. Over-supplementation can lead to adverse effects and may not address the underlying cause of fatigue in patients with acute leukemia.

Choice D rationale

Encouraging the patient to perform light exercises daily can be beneficial for overall health, but it may not be practical for someone experiencing severe fatigue and breathlessness. The patient's immediate need for oxygen support during activities takes precedence, and physical activity should be tailored to their current capabilities and medical condition. .

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with severe malnutrition is admitted to the hospital.Which intervention should the nurse implement first?

Correct Answer is A

Explanation

Correct Answer is B

Explanation

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