Med Surg II - Chapter 63 - Care of Patients with Problems of the Thyroid and Parathyroid Glands

What does hyperparathyroidism cause? 1 Anemia 2 Hypercalcemia 3 Hypernatremia 4 Hyperphosphatemia

2 Hypercalcemia Hyperparathyroidism causes hypercalcemia, which is excessive levels of calcium in the blood. Hyperparathyroidism does not cause anemia, hypernatremia, or hyperphosphatemia. Anemia is low iron. Hypernatremia is excessive sodium. Hyperphosphatemia is excessive phosphorus. Hyperparathyroidism causes hypophosphatemia (low levels of phosphorus), not hyperphosphatemia.

What is hyperplasia? 1 Cellular decay 2 Tissue overgrowth 3 Excessive hydration 4 Tingling and numbness

2 Tissue overgrowth Hyperplasia is tissue overgrowth and is one of the causes of hyperparathyroidism. Cellular decay, excessive hydration, and tingling and numbness do not describe hyperplasia.

A patient underwent a parathyroid function test, and the results were serum calcium of 12 mg/dL and serum magnesium of 3 mEq/L. What levels of serum phosphorus should the nurse expect? 1 2 mg/dL 2 3 mg/dL 3 4 mg/dL 4 5 mg/dL

1 2 mg/dL The serum levels of calcium, magnesium, and phosphorus of a normal adult are 9-10 mg/dL, 1.3-2.1 mEq/dL, and 3-4.5 mg/dL respectively. In hyperparathyroidism, the serum levels of calcium and magnesium are increased, and the serum phosphorus level is decreased. The calcium and magnesium levels in the given scenario indicate hyperparathyroidism. Therefore, the nurse expects the serum phosphorus level to be below normal, or 2 mg/dl. 3 mg/dL and 4 mg/dL are considered normal, and 5 mg/dL is slightly elevated.

If a patient has hyperparathyroidism and receives hydration therapy, how often does the nurse monitor the patient? 1 Every 2 hours 2 Every 12 hours 3 Every 16 hours 4 Every 30 minutes

1 Every 2 hours When a patient with hyperparathyroidism receives hydration therapy, the nurse monitors and checks on the patient every two hours. The nurse must check on the patient more often than every 12 or 16 hours but not as often as every 30 minutes.

What does the nurse teach a patient with hypoparathyroidism about treating hypocalcemia? 1 Include foods that are high in calcium. 2 Include milk, yogurt, and cheese in the daily diet. 3 Long-term oral therapy for calcium is 2 to 4 g daily. 4 Treatment is stopped after desired calcium levels are achieved.

1 Include foods that are high in calcium. The patient with hypocalcemia should include foods high in calcium to overcome calcium deficiency. However, foods such as milk, yogurt, and cheese must be avoided in the daily diet because of their phosphorus content. Long-term oral therapy for calcium is 0.5 to 2 g daily in divided doses. Hypocalcemia requires lifelong therapy; if the patient adheres to the prescribed drug and diet regimen, calcium levels should remain high enough to prevent hypocalcemic crisis.

A patient with hyperparathyroidism is prescribed calcitonin with glucocorticoids. How does this drug work to lower serum calcium levels? 1 It prevents bone resorption. 2 It lowers the levels of free calcium. 3 It interferes with calcium absorption. 4 It reduces the release of skeletal calcium.

1 It prevents bone resorption. Calcitonin is a short-acting drug. The therapeutic effect is greatly enhanced when given along with glucocorticoids. Calcitonin works to lower serum calcium levels by decreasing bone resorption and increasing the excretion of calcium by the kidneys. Oral phosphates inhibit bone resorption and interfere with calcium absorption. Calcium chelators, such as mithramycin, lower the calcium level by binding calcium. This reduces the level of free calcium.

What is the nursing priority for a patient with chronic hyperparathyroidism? 1 Preventing injury 2 Reducing stimulation 3 Encouraging exercise 4 Reducing room temperature

1 Preventing injury The nursing priority for a patient with chronic hyperparathyroidism is preventing injury. The patient has loss of bone density and is at risk for pathologic fractures. The patient with hyperthyroidism cannot tolerate heat, and the nursing priority for this patient is to reduce room temperature. The nurse does not encourage the patient with chronic hyperparathyroidism to exercise because the patient is susceptible to injury. The patient with hyperthyroidism requires a stress-free environment to prevent risk for cardiac complications. The nursing priority for this patient is to reduce stimulation.

A nurse is caring for a patient with hyperparathyroidism. Which laboratory finding indicates a high risk of psychosis? 1 Serum calcium 15 mg/dL 2 Serum phosphorus 3.1 mg/dL 3 Serum magnesium 2.1 mEq/L 4 Serum parathyroid hormone 60 pg/mL

1 Serum calcium 15 mg/dL The normal serum calcium concentration ranges from 8.5 to 10.2 mg/dL. A serum calcium level greater than 12 mg/dL indicates that the patient is at a high risk for psychosis. The normal serum concentration of phosphorus ranges from3.0 to 4.5 mg/dL, so a value of 3.1 mg/dL is normal. The normal serum concentration of magnesium ranges from1.3 to 2.1 mEq/L, a value of 2.1 mEq/L is normal. The normal serum concentration of parathyroid hormone ranges from 10 to 65 pg/mL, so a value of 60 pg/mL is normal.

While assessing a patient with hypoparathyroidism, the nurse observes severe muscle cramps and elbow flexion. Which condition does the nurse suspect? 1 Severe hypocalcemia 2 Moderate hyperkalemia 3 Severe hypomagnesemia 4 Moderate hyperphosphatemia

1 Severe hypocalcemia Severe muscle cramps indicate severe hypocalcemia. Moderate hyperkalemia is associated with arrhythmias and muscle weakness. Severe hypomagnesemia is associated with malnutrition. Moderate hyperphosphatemia damages the skeletal muscle tissues.

The primary health care provider prescribes intravenous phosphates to a patient with hyperparathyroidism. The patient reports tingling and numbness in the muscles after the treatment. What could be the reason behind this? 1 Sudden drop in serum calcium levels 2 Sudden drop in serum magnesium levels 3 Sudden drop in serum phosphorus levels 4 Sudden drop in serum parathyroid hormone (PTH) levels

1 Sudden drop in serum calcium levels Patients with hyperparathyroidism are prescribed oral and intravenous phosphates. Intravenous phosphates are used only when the serum calcium levels need to be lowered rapidly. This rapid decrease in the serum calcium levels causes tingling and numbness in the muscles. Intravenous administration of phosphates does not alter the serum magnesium levels. Decreased serum phosphorus levels may not cause tingling and numbness in the muscles. Intravenous administration of phosphates does not decrease the serum parathyroid hormone (PTH) levels.

Which is a nonsurgical treatment for hypoparathyroidism? 1 Vitamin therapy 2 Diuretic therapy 3 Hydration therapy 4 Calcimimetic therapy

1 Vitamin therapy Vitamin therapy to correct vitamin D deficiency is a nonsurgical treatment used for patients with hypoparathyroidism. Diuretic, hydration, and calcimimetic therapy are nonsurgical interventions for patients with hyperparathyroidism, not hypoparathyroidism.

What integumentary change does the nurse expect while assessing the skin of a patient with hyperparathyroidism? 1 Waxy pallor 2 Diaphoresis 3 Soft body hair 4 Cool, dry skin

1 Waxy pallor The patient with long-standing hyperparathyroidism may have a waxy pallor. Hyperthyroidism causes diaphoresis or excessive sweating because of heat intolerance. The patient also has soft body hair with hyperthyroidism. Cool, dry skin is found in the patient with hypothyroidism as a result of intolerance to cold.

The primary health care provider prescribes 400,000 units of oral ergocalciferol to a patient with hypoparathyroidism. Which assessment finding supports the intervention? 1 Decreased serum calcium levels 2 Decreased serum vitamin D levels 3 Decreased serum magnesium levels 4 Decreased serum phosphorous levels

2 Decreased serum vitamin D levels Hypoparathyroidism is characterized by deficiency of calcium, magnesium, and vitamin D. Long-term therapy for vitamin D deficiency is 400,000 units of oral ergocalciferol. Decreased serum calcium levels are treated with intravenous administration of calcium chloride or calcium gluconate. Decreased serum magnesium level is treated with intravenous administration of magnesium sulfate. Decreased serum phosphorous levels are treated with oral replacement of phosphorus along with A vitamin D supplement.

A patient had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? 1 Sore throat 2 Hoarseness 3 Pain on moving the head 4 Edema at the surgical site

2 Hoarseness Hoarseness or stridor is an indication of respiratory distress and requires immediate attention. Edema at the surgical site of any surgery is an expected finding. Pain when the patient moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a patient has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for patients who have had surgery involving the neck.

What type of parathyroid disorder would the nurse expect to find in patients with chronic kidney disease? 1 Hypocalcemia 2 Hypomagnesemia 3 Hyperparathyroidism 4 Iatrogenic hypoparathyroidism

2 Hypomagnesemia Hypomagnesemia may cause hypoparathyroidism. Hypomagnesemia is seen in patients with chronic kidney disease, malabsorption syndrome, and malnutrition. Hypocalcemia may not be seen in patients with chronic kidney disease but is seen in patients with hypoparathyroidism. Hyperparathyroidism is not seen in patients with chronic kidney disease but is diagnosed secondary to kidney failure. Iatrogenic hypoparathyroidism is caused by a total thyroidectomy or parathyroidectomy.

What is the most common form of hypoparathyroidism? 1 Idiopathic 2 Iatrogenic 3 Hypomagnesemia 4 Hypophosphatemia

2 Iatrogenic Iatrogenic hypoparathyroidism is the most common form of hypoparathyroidism and is caused by the removal of all parathyroid tissue during total thyroidectomy or removal of the parathyroid glands themselves. Idiopathic hypoparathyroidism can occur spontaneously, but is not the most common form. Hypomagnesemia is decreased serum magnesium levels, which can cause hypoparathyroidism, but is not a form of hypoparathyroidism. Hypophosphatemia is inadequate phosphorus, not a form of hypoparathyroidism.

A patient with hyperparathyroidism is being treated with cinacalcet. The primary health care provider wants the patient to discontinue cinacalcet and begin furosemide. Which condition does the nurse suspect? 1 Parathyroid carcinoma 2 Mild hyperparathyroidism 3 Severe primary hyperparathyroidism 4 Severe secondary hyperparathyroidism

2 Mild hyperparathyroidism Furosemide is the drug of choice for mild hyperparathyroidism. The patient might have had remission of symptoms, which improved from severe hyperparathyroidism to mild hyperparathyroidism. Therefore, furosemide is chosen to treat the patient. Cinacalcet is the drug of choice in cases of parathyroid carcinoma, severe primary hyperparathyroidism, and secondary hyperparathyroidism.

While assessing a patient with hypoparathyroidism, the patient reports tingling and numbness of the hands and feet. Which condition does the nurse suspect? 1 Severe hypokalemia 2 Moderate hypocalcemia 3 Severe hypophosphatemia 4 Moderate hypermagnesemia

2 Moderate hypocalcemia Moderate hypocalcemia presents with tingling and numbness of the hands and feet. Severe hypokalemia causes flaccid paralysis. Severe hypophosphatemia causes muscle dysfunction and weakness. Moderate hypermagnesemia causes weakness.

A patient recently admitted with hyperparathyroidism has a very high urine output during the previous shift. Of these actions, what does the nurse do next? 1 Slows the rate of IV fluids. 2 Monitors intake and output. 3 Calls the health care provider. 4 Performs an immediate cardiac assessment.

2 Monitors intake and output. Diuretic and hydration therapies are used most often for reducing serum calcium levels in patients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion. The health care provider does not need to be notified in this situation, given the information available in the question. Cardiac assessment is part of the nurse's routine evaluation of the patient. Slowing the rate of IV fluids is contraindicated because the patient will become dehydrated because of the use of diuretics to increase kidney excretion of calcium.

What manifestation does the nurse expect to find in a patient with hyperparathyroidism? 1 Weight gain 2 Presence of renal calculi 3 Decreased serum gastrin 4 Serum calcium less than 9 mg/dL

2 Presence of renal calculi X-rays for the patient with hyperparathyroidism show the presence of renal calculi and deposits of calcium in the soft tissue of the kidney because of hypercalcemia. Increased serum calcium levels lead to an elevated serum gastrin level, which leads to peptic ulcer. Serum calcium levels are generally greater than 12 mg/dL. Fatigue and lethargy become more severe as serum calcium levels rise. The patient with high serum calcium levels develops gastrointestinal problems, such as anorexia, nausea, and weight loss.

The registered nurse is teaching a student nurse about the care plan for a patient with hypoparathyroidism. Which statement made by the student nurse indicates a need for further teaching? 1 "I will counsel the patient to help decrease the anxiety." 2 "I will advise the patient to wear a medical alert bracelet." 3 "I will explain to the patient that hypocalcemia therapy is short-term." 4 "I will teach the patient about the necessary dietary changes to increase calcium intake and decrease phosphorous intake."

3 "I will explain to the patient that hypocalcemia therapy is short-term." Hypocalcemia therapy in a patient with hypoparathyroidism is long-term, not short-term. The nursing care plan includes teaching the patient to reduce anxiety. The patient should be advised to wear a medical alert bracelet for easy identification. Patients with parathyroidism should avoid processed cheese, milk, and yogurt because of their high phosphorus content. Foods rich in calcium and low in phosphorus should be eaten.

What kinds of gastrointestinal (GI) problems are common when serum calcium levels are high? Select all that apply. 1 Obesity 2 Diarrhea 3 Anorexia 4 Vomiting 5 Constipation

3 Anorexia 4 Vomiting 5 Constipation When serum calcium levels are high, a patient may experience anorexia, vomiting, and constipation. Obesity and diarrhea are not associated with high serum calcium levels.

Which class of drugs is most appropriate for treating severe hyperparathyroidism? 1 Diuretics 2 Hormones 3 Calcimimetics 4 Glucocorticoids

3 Calcimimetics Drug therapy for patients with severe hyperparathyroidism involves the use of cinacalcet. This medication belongs to the calcimimetics drug class. Diuretics are used to reduce serum calcium levels in patients who have milder hyperparathyroidism. Hormone replacement therapy is used to treat the symptoms of endocrine disorders. Therapeutic effects are greatly enhanced if calcitonin is given along with glucocorticoids.

The nurse knows to assess serum calcium levels for the patient with hyperparathyroidism because of which mechanism? 1 Increased osteoblastic activity in the bone 2 Decreased osteoclastic activity in the bone 3 Increased reabsorption of calcium by the kidneys 4 Increased reabsorption of phosphate by the kidneys

3 Increased reabsorption of calcium by the kidneys Increased levels of parathyroid hormone (PTH) cause the kidneys to reabsorb calcium, causing hypercalcemia. Hypercalcemia also occurs if there is decreased osteoblastic activity, or bone production. Similarly, an increased osteoclasticactivity, or bone destruction, also causes hypercalcemia. Increased reabsorption of phosphate by the kidneys causes hyperkalemia.

What finding during the physical assessment of a patient does the nurse associate with hypoparathyroidism? 1 Intolerance to heat 2 Decreased attention span 3 Presence of bands on the teeth 4 Wide-eyed or startled appearance

3 Presence of bands on the teeth The patient with hypoparathyroidism has bands on the teeth from loss of enamel because of hypocalcemia. Hyperthyroidism causes intolerance to heat and excessive sweating. It also causes a decreased attention span from fatigue because of an inability to sleep well. The patient with hyperthyroidism also has a wide-eyed or startled appearance because of edema in the extraocular muscles.

A patient is suspected of having hyperparathyroidism. Which treatment strategy would be therapeutically effective in this patient? 1 Calcitonin 2 Furosemide 3 Intravenous phosphates 4 Calcitonin with glucocorticoids

4 Calcitonin with glucocorticoids Calcitonin decreases the release of skeletal calcium and increases the kidney excretion of calcium. The therapeutic effects of calcitonin are greatly enhanced if it is given along with glucocorticoids. It is not effective when used alone because of its short duration of action. Furosemide is used in reducing serum calcium levels in patients who have a milder disease. Intravenous phosphates are used only when the serum calcium levels need to be lowered rapidly.

What are the parathyroid glands responsible for maintaining? 1 Iodine and iron balance 2 Calcium and iodine balance 3 Sodium and electrolyte balance 4 Calcium and phosphate balance

4 Calcium and phosphate balance The parathyroid glands maintain calcium and phosphate balance. They do not maintain the balance of iodine and iron, calcium and iodine, or sodium and electrolytes.

What is a common cause of hypoparathyroidism? 1 Neck trauma 2 Hypocalcemia 3 Vitamin K deficiency 4 Congenital dysgenesis

4 Congenital dysgenesis Congenital dysgenesis is one of the common causes of hypoparathyroidism. Neck trauma causes hyperparathyroidism. Hypocalcemia causes chronic kidney disease. Vitamin K deficiency causes hyperparathyroidism.

Which electrolyte disturbance causes hypoparathyroidism? 1 Hyperkalemia 2 Hyponatremia 3 Hypercalcemia 4 Hypomagnesemia

4 Hypomagnesemia Hypomagnesemia is a decreased serum magnesium level, which causes impairment of parathyroid hormone secretion. This results in hypoparathyroidism. Hyperkalemia is characterized by increased serum potassium levels and is not a cause of hypoparathyroidism. Hyponatremia is characterized by decreased serum sodium levels, which are seen in patients with impaired thyroid and parathyroid hormone function. Hypercalcemia is characterized by increased serum calcium levels, which are seen in patients with hyperparathyroidism.

What parathyroid disorder is associated with a total thyroidectomy? 1 Hypercalcemia 2 Hypomagnesemia 3 Idiopathic hypoparathyroidism 4 Iatrogenic hypoparathyroidism

4 Iatrogenic hypoparathyroidism Iatrogenic hypoparathyroidism is a parathyroid disorder that is associated with a total thyroidectomy. Hypercalcemia is associated with hyperparathyroidism. Hypomagnesemia is associated with chronic kidney disease, malnutrition, and malabsorption syndrome. Idiopathic hypoparathyroidism is associated with disorders such as adrenal insufficiency, diabetes mellitus, and hypothyroidism.

A patient has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? 1 Visitors talking with the patient about going home 2 The patient eating a morning meal of cereal and fruit 3 The physical therapist walking with the patient in the hallway 4 Unlicensed assistive personnel (UAP) pulling the patient up in bed by the shoulders

4 Unlicensed assistive personnel (UAP) pulling the patient up in bed by the shoulders The patient with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the patient carefully. A lift sheet should be used to reposition the patient. The patient with hyperparathyroidism is not restricted from eating and should maintain a balanced diet. The patient can benefit from moderate exercise and physical therapy, and is not restricted from having visitors.