Calcium Preparations, Vitamin D, Bisphosphonates, Calcimimetics, and Peptide Hormones

Every question here, with the answer

1. A client is starting oral alendronate for osteoporosis. Which instruction should the nurse include?

   1. Take it with 6–8 ounces of water and stay sitting or standing for at least 30 minutes.
   2. Take it with a small sip of juice at bedtime.
   3. Lie down for 30 minutes after taking it to prevent dizziness.
   4. Take it together with your calcium supplement.

   Answer: Take it with 6–8 ounces of water and stay sitting or standing for at least 30 minutes.

   Alendronate is taken with 6–8 ounces of water, and the client stays upright at least 30 minutes to prevent esophageal irritation. Lying down raises that risk, and calcium supplements interact with alendronate and interfere with absorption.

2. A client taking calcium carbonate reports new symptoms. Which findings suggest hypercalcemia? Select all that apply.

   1. Confusion
   2. Numbness and tingling of the lips
   3. Frequent urination
   4. Increased thirst
   5. Muscle cramps

   Answer: Confusion, Frequent urination, Increased thirst

   Hypercalcemia causes fatigue, confusion, constipation, increased thirst and frequent urination. Tingling of the lips and muscle cramps are listed as symptoms of hypocalcemia, the opposite problem.

3. A client receiving cinacalcet for hyperparathyroidism reports muscle cramps and numbness in the fingers and lips. What should the nurse suspect?

   1. Hypocalcemia
   2. Vitamin D toxicity
   3. Osteonecrosis of the jaw
   4. Hypercalcemia

   Answer: Hypocalcemia

   Calcimimetics lower blood calcium, and hypocalcemia shows as muscle cramps, tingling, numbness in the fingers or lips, and seizures. Hypercalcemia causes thirst and frequent urination instead, and the other options do not match these symptoms.

4. A client takes levothyroxine and has just been prescribed a calcium supplement. What should the nurse teach?

   1. Take the calcium only with coffee.
   2. Take the two drugs at separate times.
   3. Stop the levothyroxine while taking calcium.
   4. Take both together so you do not forget.

   Answer: Take the two drugs at separate times.

   Thyroid hormone replacements interfere with calcium absorption, so the two are taken at separate times. Stopping levothyroxine is not advised, and taking them together defeats absorption.

5. The nurse reviews the chart of a client prescribed a bisphosphonate. Which findings are contraindications? Select all that apply.

   1. Postmenopausal osteoporosis
   2. Paget's disease
   3. Inability to sit upright for 30 minutes
   4. Hypocalcemia
   5. Severe renal impairment

   Answer: Inability to sit upright for 30 minutes, Hypocalcemia, Severe renal impairment

   Bisphosphonates are excreted by the kidneys and can worsen severe renal impairment, need the client upright after the dose, and are contraindicated in hypocalcemia. Postmenopausal osteoporosis and Paget's disease are indications.

6. A client preparing to self-inject calcitonin salmon notices the vial solution looks cloudy. What should the nurse tell the client to do?

   1. Discard the solution.
   2. Inject it but at half the volume.
   3. Shake the vial until it clears, then inject.
   4. Warm the vial in the hands before injecting.

   Answer: Discard the solution.

   The client should inspect the vial and discard the solution if it is not clear and colorless, contains particles, or the vial is damaged. Shaking, warming or giving a smaller amount does not make the solution safe to use.