Chapter 58, Concepts of Care for Patients With Problems of the Thyroid and Parathyroid Glands

Do you have a history of fractures, Do you have a history of joint pain?, Do you have a history of radiation therapy to the neck?

A nurse is assessing a patient suspected of having hyperparathyroidism. Which question would the nurse ask the patient? Select all that apply. One, some, or all responses may be correct.

Serum calcium 15 mg/dL

A nurse is caring for a patient with hyperparathyroidism. Which laboratory finding indicates a high risk for psychosis?

Binds to calcium-sensitive receptors, Reduces parathyroid hormone production (PTH) and release, Decreases serum calcium levels, Decreases parathyroid hormone-induced bone complications

A patient diagnosed with parathyroid cancer is prescribed cinacalcet. In which order do the drug actions occur?

Vitamin D deficiency

A patient is prescribed 50,000 units of ergocalciferol daily. Which disorder would the nurse suspect is being treated in this patient?

Assistive personnel (AP) pulling the patient up in bed by the shoulders

A patient on the nursing unit has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention?

Monitor intake and output.

A patient recently admitted with hyperparathyroidism had a very high urine output during the previous shift. Which action would the nurse take?

"Your calcium levels need to be kept in the low range to prevent kidney stones.

A patient who has hypoparathyroidism related to vitamin D deficiency receives a prescription for oral ergocalciferol. The health care provider informs the patient that the dosage will be adjusted throughout the therapy, but the patient is confused about the reason. Which information would the nurse provide to the patient?

Parathyroid disorder

A patient with a history of radiation therapy to the neck has bone degeneration and an electrolyte imbalance. Which condition is the likely cause?

Mild hyperparathyroidism

A patient with hyperparathyroidism is being treated with cinacalcet. The primary health care provider recommends that the patient discontinue cinacalcet and begin furosemide. Which condition would the nurse suspect?

It reduces the release of skeletal calcium

A patient with hyperparathyroidism is prescribed calcitonin with glucocorticoids. Which action of the drug lowers serum calcium levels?

Severe hypocalcemia

A patient with hypoparathyroidism reports severe muscle cramps. Which condition would the nurse suspect?

2 mg/dL

A patient's parathyroid function test results were serum calcium of 12 mg/dL and serum magnesium of 3 mEq/L. Which level of serum phosphorus would the nurse expect to see?

Measure the patient's intake and output hourly

An older patient with an elevated serum calcium level is receiving IV furosemide and an infusion of normal saline at 150 mL/hr. Which nursing action would the registered nurse (RN) delegate to assistive personnel (AP)?

Every 2 hours

How often would the nurse monitor the patient with hyperparathyroidism who is receiving hydration therapy?

Do you have any history of bone fractures, Have you lost or gained any weight recently?, Have you received any radiation treatment to the neck or head?

The nurse assesses a patient who has symptoms of hyperparathyroidism. Which question would the nurse ask the patient? Select all that apply. One, some, or all responses may be correct.

Notify the health care provider.

The nurse cares for a patient whose laboratory report shows serum calcium levels of 13 mg/dL. Which action would the nurse take first?

Yogurt with banana

The nurse educates the patient with hypoparathyroidism about dietary intake and nutrition. Which food selection made by the patient indicates further teaching is required?

I will avoid milk., I will avoid yogurt, I will avoid processed cheese.

The nurse is providing instructions about dietary changes to a patient with hypoparathyroidism. Which statement made by the patient indicates effective learning? Select all that apply. One, some, or all responses may be correct.

Patient A

The nurse is reviewing the clinical data of four patients. Which patient is at high risk for bone fractures?

Patient C

The nurse is reviewing the clinical data of four patients. Which patient is at high risk for peptic ulcer?

Oral administration of 2 mg calcitriol daily, IV administration of 10% calcium chloride, IV administration of 50% magnesium sulfate

The nurse is reviewing the laboratory results of a patient with hypoparathyroidism. Which intervention would the nurse plan to implement? Select all that apply. One, some, or all responses may be correct.

Drinks large amounts of water and fluids

The nurse teaches a patient with hyperparathyroidism about self-management. Which action by the patient indicates effective action for reducing the incidence of renal calculi?

Decreased serum vitamin D levels

The primary health care provider prescribes 400,000 units of oral ergocalciferol to a patient with hypoparathyroidism. Which assessment finding supports this intervention?

Sudden drop in serum calcium levels

The primary health care provider prescribes IV phosphates to a patient with hyperparathyroidism. The patient reports tingling and numbness in the muscles after the treatment. Which change would explain the patient's symptoms?

Patient who had a parathyroidectomy yesterday and has muscle twitching

The registered nurse (RN) has just received a change-of-shift report on the medical-surgical unit. Which patient would the nurse assess first?

Anorexia, Vomiting, Constipation

Which GI problem is common when a patient has a high serum calcium level? Select all that apply. One, some, or all responses may be correct.

Calcimimetics

Which class of drugs is used to reduce a patient's parathyroid hormone (PTH) production?

Moderate hypocalcemia

Which condition would the nurse suspect in a patient who reports tingling and numbness of the hands and feet?

Decreased osteoblastic activity

Which consequence results from the action of parathyroid hormone (PTH) on the bones?

Calcium, Phosphate

Which element does the parathyroid glands help keep in balance? Select all that apply. One, some, or all responses may be correct.

Vitamin D deficiency

Which factor is a cause of hyperparathyroidism?

Hypomagnesemia

Which factor is a cause of hypoparathyroidism?

Removal of the glands

Which factor is the cause of iatrogenic hypoparathyroidism?

Stridor

Which finding requires immediate attention for a patient who had a parathyroidectomy 18 hours ago?

Soy milk

Which food would the nurse recommend for the patient with hypoparathyroidism to include in the diet?

Iatrogenic

Which form of hypoparathyroidism is the most common?

Eat foods that are high in calcium but low in phosphorus.

Which information would the nurse teach a patient with hypoparathyroidism about treating hypocalcemia?

Waxy pallor

Which integumentary change would the nurse expect while assessing the skin of a patient who has hyperparathyroidism?

Serum calcium level of 11 mg/dL

Which laboratory finding would the nurse expect in a patient who has hyperparathyroidism?

Serum magnesium level of 1 mEq/L, Serum phosphorus level of 6.5 mg/dL, Decreased level of urine cyclic adenosine monophosphate (cAMP) nmol/L

Which laboratory value would the nurse expect for a patient who has a diagnosis of hypoparathyroidism? Select all that apply. One, some, or all responses may be correct.

Calcium

Which long-term therapy would the nurse expect to be prescribed for a patient with hypoparathyroidism who has a serum calcium level of 8 mg/dL?

Presence of renal calculi

Which manifestation would the nurse expect in a patient who has hyperparathyroidism?

Increased reabsorption of calcium by the kidneys

Which mechanism alters serum calcium levels in the patient with hyperparathyroidism?

Calcitonin

Which medication would the nurse anticipate being prescribed for a patient with hyperparathyroidism?

Preventing injury

Which outcome is the nursing priority for a patient who has chronic hyperparathyroidism?

Presence of bands on the teeth

Which patient assessment finding is associated with hypoparathyroidism?

Congenital dysgenesis

Which patient condition would the nurse identify as increasing the risk for hypoparathyroidism?

Positive Trousseau test

Which postoperative assessment finding in a patient who underwent a parathyroidectomy indicates potential tetany?

Bone cysts, Renal calculi, Osteoporosis

Which radiologic finding would the nurse expect when reading the health record of a patient with hyperparathyroidism? Select all that apply. One, some, or all responses may be correct.

14 mg/dL

Which serum calcium level puts a patient at high risk for coma?

Vitamin therapy

Which treatment would the nurse expect to be prescribed for a patient who has hypoparathyroidism?

Calcitriol

Which treatment would the nurse expect to be prescribed for a patient with acute vitamin D deficiency?