Chapter 74: Drugs Affecting Calcium Levels and Bone Mineralization

Chapter 74: Drugs Affecting Calcium Levels and Bone Mineralization

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A review of a patient’s laboratory test results indicates that the patient’s serum calcium is 14.8 mg/dL. The nurse determines that which factors may predispose the patient to this condition? (Select all that apply.)

a.	Hyperparathyroidism
b.	Cushing’s syndrome
c.	Osteoporosis
d.	Use of thiazide diuretics
e.	Cancer

 

 

ANS:   A, D, E

The upper limit for a normal serum calcium level is 10 mg/dL. The patient’s laboratory results demonstrate hypercalcemia, which most often results from cancer, hyperparathyroidism, vitamin D intoxication, sarcoidosis, and use of thiazide diuretics.

In Cushing’s syndrome the serum calcium is low.

Osteoporosis is characterized by low bone mass, altered bone architecture, and increased bone fragility. Adequate calcium and vitamin D (for absorption of calcium) are needed to maximize bone growth in early life and maintain bone integrity in later life. Nothing suggests that the patient is taking calcium supplements.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 870

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

2. The nurse is caring for a patient with a history of Paget’s disease of the bone. The prescriber has ordered tiludronate (Skelid), and the nurse provides patient education. Which statement by the patient demonstrates a need for further teaching?

a.	“I should report any new heartburn.”
b.	“I should report any difficulty with swallowing.”
c.	“I may experience ringing in my ears.”
d.	“I may feel muscle aches or pain.”

 

 

ANS:   C

Ringing in the ears is not an adverse effect of tiludronate; this statement indicates that the patient needs further teaching to become familiar with side effects, specifically those that require that treatment be stopped.

Dyspepsia or heartburn is a common side effect of tiludronate; no further teaching is needed.

Tiludronate use increases the risk for esophagitis, which may manifest as difficulty swallowing; no further teaching is needed.

An adverse effect of tiludronate is musculoskeletal pain; no further teaching is needed.

 

DIF:    Cognitive Level: Application             REF:    p. 876

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. The nurse is providing education to a patient who is to be discharged home on alendronate (Fosamax). Which complication should the patient be instructed to report immediately?

a.	Drowsiness
b.	Pallor
c.	Dizziness
d.	Difficulty swallowing

 

 

ANS:   D

Esophagitis is the most serious adverse effect of alendronate, sometimes resulting in ulceration. The nurse should instruct the patient immediately to report difficulty swallowing, which can be a sign of esophageal injury.

Drowsiness is not a symptom associated with alendronate.

Pallor is not a symptom associated with alendronate.

Dizziness is not an adverse effect of alendronate.

 

DIF:    Cognitive Level: Application             REF:    p. 875

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. The nurse is preparing to administer parenteral calcium chloride. The nurse will administer the medication

a.	deep into the deltoid muscle with a 2-inch, 19-gauge needle.
b.	into the subcutaneous tissue with a -inch needle.
c.	by rapid intravenous (IV) injection after mixing the calcium with phosphates.
d.	by slow IV injection after warming the solution to body temperature.

 

 

ANS:   D

The nurse should administer the medication by slow IV injection. Solutions of calcium salts, such as calcium chloride, should be warmed to body temperature prior to administration.

Calcium chloride cannot be administered intramuscularly.

Injection of calcium chloride into subcutaneous tissue can lead to sloughing and necrosis of the tissue.

Drugs that contain phosphate can precipitate calcium and should not be mixed with it.

 

DIF:    Cognitive Level: Application             REF:    p. 871

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies