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Which of the following actions should a nurse take when managing a patient with hyperparathyroidism to prevent complications related to hypercalcemia? Select All that Apply

Reassure the patient that hyperparathyroidism will resolve on its own.

Encourage the patient to stay well-hydrated by increasing oral fluid intake.

Monitor for signs of dehydration regularly.

Schedule regular follow-up lab tests to monitor calcium levels.

Encourage intake of milk, milk products, and egg yolks.

Administer calcium supplements with vitamin D as prescribed.

Educate about dietary restrictions, particularly increasing phosphorus intake.

Instruct the patient to limit their physical activity completely.

Answer and Explanation

Correct Answer : B,C,D,G

Rationale:

A. Hyperparathyroidism, whether primary (due to parathyroid adenoma, hyperplasia, or carcinoma) or secondary (commonly related to chronic kidney disease), does not resolve spontaneously. Without appropriate management, persistent elevated parathyroid hormone (PTH) levels can lead to chronic hypercalcemia, kidney stones, bone demineralization (osteopenia/osteoporosis), and cardiovascular complications. Telling the patient it will resolve on its own is misleading and can delay necessary interventions.

B. Adequate hydration is a primary preventive measure in hyperparathyroidism. High calcium levels increase renal calcium excretion but can also promote calcium stone formation if fluid intake is insufficient. Drinking 2–3 liters of water daily, unless contraindicated, helps dilute urinary calcium and reduce the risk of kidney stones. Hydration also helps prevent the dehydration that often accompanies hypercalcemia due to polyuria.

C. Hypercalcemia can cause polyuria, nausea, vomiting, and weakness, all of which increase the risk of dehydration. The nurse should assess skin turgor, mucous membranes, blood pressure, heart rate, and daily weight to detect fluid loss early. Timely detection allows for prompt interventions such as oral or IV fluid replacement, reducing complications such as hypotension or acute kidney injury.

D. Laboratory monitoring is essential for tracking disease progression and evaluating treatment effectiveness. Key labs include serum calcium, phosphate, PTH, creatinine, and 25-hydroxy vitamin D levels. Frequent monitoring allows clinicians to adjust interventions, such as recommending surgery or pharmacologic treatment (e.g., bisphosphonates or calcimimetics), before severe complications occur.

E. These foods are high in calcium, which can exacerbate hypercalcemia in patients with hyperparathyroidism. Dietary calcium restriction is often advised to prevent further elevation of serum calcium levels, although strict restriction is usually balanced with maintaining adequate calcium for bone health.

F. Calcium supplements are generally avoided in hyperparathyroidism unless the patient has undergone parathyroidectomy and is at risk for hypocalcemia. Unmonitored supplementation can worsen hypercalcemia and increase the risk of kidney stones and cardiovascular complications.

G. In primary hyperparathyroidism, PTH increases calcium reabsorption and phosphate excretion, leading to hypophosphatemia. Encouraging foods higher in phosphorus (e.g., meat, poultry, fish, eggs, and some whole grains) can help balance calcium-phosphate levels, reduce hypercalcemia complications, and support bone health.

H. While high-impact activity or excessive strain should be avoided due to bone fragility, complete inactivity is not recommended. Moderate weight-bearing exercise helps maintain bone density, prevent muscle loss, and support overall cardiovascular health. Limiting all activity could worsen osteopenia, muscle weakness, and functional decline.

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Correct Answer is A

Explanation

Rationale:

A. Levothyroxine is usually a lifelong therapy for primary hypothyroidism. Stopping the medication once thyroid hormone levels normalize can lead to a return of hypothyroid symptoms and potential complications such as fatigue, bradycardia, and weight gain. Patients must understand that normalization of lab values does not mean the underlying thyroid deficiency is cured.

B. Regular monitoring of TSH and free T4 is essential to ensure the dose is appropriate and to prevent over- or under-replacement. Lab checks are typically done 6–8 weeks after starting or adjusting therapy and periodically thereafter.

C. Consistent daily use is critical because missing doses can lead to fluctuating thyroid hormone levels and recurrence of hypothyroid symptoms.

D. Levothyroxine absorption is maximized on an empty stomach, typically 30–60 minutes before breakfast, and should be taken separately from medications or supplements (like calcium or iron) that can impair absorption.

A. Evaluate the patient's muscle strength in extremities. B. Assess the patient's respiratory status and ability to breathe. C. Obtain a complete health history to identify triggers. D. Check the patient's blood glucose levels.

Correct Answer is B

Explanation

Rationale:

A. While assessing extremity strength is important for overall neuromuscular function, it is not the immediate priority in a myasthenic crisis. Muscle weakness in the limbs does not pose an immediate threat to life, whereas respiratory compromise does.

B. Myasthenic crisis can cause severe weakness of the respiratory muscles, leading to hypoventilation, respiratory failure, and potential respiratory arrest. Assessing airway patency, respiratory rate, oxygen saturation, and effort is the highest priority because preserving oxygenation and ventilation is critical to prevent life-threatening complications.

C. Gathering a history is important for understanding contributing factors and planning long-term care, but it is secondary to addressing immediate life-threatening respiratory compromise.

D. Blood glucose monitoring is not directly related to the acute management of a myasthenic crisis. It does not address the critical risk of respiratory failure, which takes precedence.

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Which of the following actions should a nurse take when managing a patient with hyperparathyroidism to prevent complications related to hypercalcemia? Select All that Apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge education to a client who has been prescribed levothyroxine for hypothyroidism. Which of the following statements by the client indicates a need for further teaching?

Correct Answer is A

Explanation

A patient with myasthenia gravis presents to the emergency department in a myasthenic crisis. Which of the following assessments would be the top priority for the nurse to perform first?

Correct Answer is B

Explanation

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