Which of the following clients with myasthenia gravis are at increased risk of developing pneumonia? Select all that apply.

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.

Rationale:

A. Glucocorticoids do not improve muscle strength. In fact, long-term corticosteroid use can cause steroid-induced myopathy, which leads to muscle weakness, particularly in the proximal muscles of the thighs and shoulders. This side effect can reduce the patient’s overall physical function and mobility rather than enhancing it. Therefore, this is not an expected or beneficial effect of corticosteroid therapy.

B. Glucocorticoids are immunosuppressive, meaning they reduce the body’s ability to mount an immune response. This places the patient at increased risk of infections, including opportunistic infections. Patients should be educated to monitor for signs of infection such as fever, cough, sore throat, or unusual fatigue, and seek medical attention promptly if symptoms occur.

C. Corticosteroids affect carbohydrate, protein, and fat metabolism, which can lead to elevated blood glucose levels, particularly in patients with pre-existing diabetes or impaired glucose tolerance. They also cause fluid retention and increased vascular sensitivity to catecholamines, which can elevate blood pressure. Patients should monitor for symptoms such as increased thirst, frequent urination, fatigue, headaches, or swelling, and regularly check their blood pressure and glucose levels as recommended by their healthcare provider. This monitoring is essential to detect and manage complications early.

D. While glucocorticoids can reduce inflammation and alleviate pain during a flare-up, they do not directly improve joint mobility. Improvements in mobility are usually achieved through physical therapy, exercise, and long-term disease-modifying antirheumatic drugs (DMARDs) rather than corticosteroid therapy alone