Chapter 44
Alendronate (Fosamax) is prescribed for a patient. Which statement made by the patient will indicate to the nurse that further instruction is needed?
"I can go back to bed as soon as I take this drug." The patient must remain upright (sitting or standing) for at least 30 minutes after taking alendronate with a full glass of water. Nothing should be taken by mouth for at least 30 minutes. Upper abdominal pain or heartburn may indicate that alendronate is causing esophageal irritation or damage.
The nurse is providing client teaching regarding the administration of levothyroxine (Synthroid). What is the nurse's priority teaching point?
"Take the medication with a full glass of water." The client should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing . The medication should be taken on an empty stomach before breakfast. There is no need to maintain an upright position. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.
A nurse is discussing nutrition with a group of older adults at a community senior center. The nurse informs the group that the recommended daily calcium intake is:
1000-1500 mg
The nurse is caring for a client who is being monitored for hypercalcemia. The nurse understands that what calcium level is considered a medical emergency?
12 mg/dL
The nurse knows that phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia. Hypophosphatemia is assumed when the serum phosphorus is less than what level?
3 mg/dL Phosphates should be given only when hypercalcemia is accompanied by hypophosphatemia (serum phosphorus less than 3 mg/dL) and renal function is normal, to minimize the risk of soft tissue calcification.
A patient confides in the nurse that she is in menopause and that she does not want to take hormone replacement therapy because she has a family history of breast cancer. She tells the nurse she is taking soy, calcium, and a vitamin as an alternative therapy. What would the nurse advise the patient to do?
Discontinue her calcium supplement The nurse may advise the patient to stop using a calcium supplement. Calcium, iron, or zinc products could decrease effects of estrogen. However, the patient may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates in the diet and walking 2 miles a day should be stressed for maintenance of health, especially for a menopausal woman, but would not be related to the use of soy as an alternative therapy for the signs and symptoms of menopause.
A female client presents to the health care provider's office for a routine physical examination. The nurse assesses her current over-the-counter drug history and discovers that she takes vitamin D 600 international units daily. The nurse recognizes that the client is at risk for what condition?
Hypercalcemia Clients diagnosed with osteoporosis require adequate calcium and vitamin D (at least the recommended dietary allowance), whether obtained from the diet or from supplements. Calcium 600 mg and vitamin D 200 international units once or twice daily are often recommended for postmenopausal women with osteoporosis, and pharmacologic doses of vitamin D are sometimes used to treat clients with serious osteoporosis.
A patient is diagnosed with hypercalcemia. The nurse knows that which statement regarding hypercalcemia is correct?
Hypercalcemia can lead to calcium deposits that damage the kidneys. Vitamin D deficiency will result in hypocalcemia. Cisplatin tends to cause hypocalcemia. Hypocalcemia increases muscle tone, which can lead to twitching of facial muscles. Hypercalcemia is characterized by decreased muscle tone.
A patient is diagnosed with hypocalcemia. The nurse knows that which statement regarding hypocalcemia is correct?
Hypocalcemia can be accompanied by hyperphosphatemia. Normal blood levels of calcium are 8.5 to 10.5 mg/dL. Calcium blood levels below 8.5 mg/dL are hypocalcemia. This imbalance is characterized by increased muscle tone that can progress to tetany. Phosphorus levels are increased when calcium levels fall; thus, hypocalcemia is often accompanied by hyperphosphatemia. Several malignancies, including breast cancer and multiple myeloma, enhance decalcification of bone, leading to hypercalcemia.
In addition to calcium, what electrolyte affects parathyroid hormone (PTH) secretion?
Magnesium
The nurse is caring for a pediatric client with a new onset of hypercalcemia. What condition would be most likely to cause this altered serum calcium level?
Malignancy
When studying for a test in pharmacology, a student asks a peer group what the most important regulator of serum calcium levels in the body are. What would be the peer group's best reply?
PTH
Calcium levels are directly related to which of the following blood components?
Serum albumin
A female client presents to the emergency department with symptoms and laboratory values indicative of hypercalcemia. What IV solutions would the health care provider order to treat the hypercalcemia?
Sodium chloride (0.9%) injection (normal saline) is an IV solution that contains water, sodium, and chloride. It is included here because it is the treatment of choice for hypercalcemia and is usually effective. The sodium contained in the solution inhibits the reabsorption of calcium in renal tubules and thereby increases urinary excretion of calcium.
What is the rationale for a nurse to suggest avoiding whole grains to a client being treated for osteopenia?
Whole grains are known to interfere with calcium absorption.
What is a likely outcome of consistently low calcium levels? Select all that apply.
osteopenia laryngospasms facial muscle twitching numbness of the fingers and/or toes
Which of the following clinical manifestations are indicative of hypercalcemia? Choose all that apply.
calcium serum level > 10.5 mg/dL coma lethargy
A client diagnosed with excessive parathyroid production is prone to develop:
osteopenia
