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1. Question
The nurse is assessing a client with a lactose intolerance disorder for a suspected diagnosis of hypocalcemia. Which clinical manifestation would the nurse expect to note in the client?
Correct
Option A is the correct answer:
Rationale: A client with lactose intolerance is at risk for developing hypocalcemia, because food products that contain calcium also contain lactose. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau’s or Chvostek’s sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.
Test-Taking Strategy: Note that the three incorrect options are comparable or alike in that they reflect a hypoactivity. The option that is different is the correct option.
Incorrect
Option A is the correct answer:
Rationale: A client with lactose intolerance is at risk for developing hypocalcemia, because food products that contain calcium also contain lactose. The normal serum calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L). A serum calcium level lower than 9 mg/dL (2.25 mmol/L) indicates hypocalcemia. Signs of hypocalcemia include paresthesias followed by numbness, hyperactive deep tendon reflexes, and a positive Trousseau’s or Chvostek’s sign. Additional signs of hypocalcemia include increased neuromuscular excitability, muscle cramps, twitching, tetany, seizures, irritability, and anxiety. Gastrointestinal symptoms include increased gastric motility, hyperactive bowel sounds, abdominal cramping, and diarrhea.
Test-Taking Strategy: Note that the three incorrect options are comparable or alike in that they reflect a hypoactivity. The option that is different is the correct option.
Hypocalcemia:
The normal calcium level is 9 to 10.5 mg/dL (2.25 to 2.75 mmol/L)
Description: Hypocalcemia is a serum calcium level lower than 9.0 mg/dL (2.25 mmol/L).
Causes
Inhibition of calcium absorption from the gastrointestinal tract
Inadequate oral intake of calcium
Lactose intolerance
Malabsorption syndromes such as celiac sprue or Crohn’s disease
Inadequate intake of vitamin D
End-stage kidney disease
Increased calcium excretion
Kidney disease, polyuric phase
Diarrhea
Steatorrhea
Wound drainage, especially gastrointestinal
Conditions that decrease the ionized fraction of calcium
Hyperproteinemia
Alkalosis
Medications such as calcium chelators or binders
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of the
Nursing Interventions:
Administer calcium supplements orally or calcium intravenously.
When administering calcium intravenously, warm the injection solution to body temperature before administration and administer slowly; monitor for electrocardiographic changes, observe for infiltration, and monitor for hypercalcemia.
Administer medications that increase calcium absorption.
Aluminum hydroxide reduces phosphorus levels, causing the countereffect of increasing calcium levels.
Vitamin D aids in the absorption of calcium from the intestinal tract.
Provide a quiet environment to reduce environmental stimuli.
Initiate seizure precautions.
Move the client carefully, and monitor for signs of a pathological fracture.
Keep 10% calcium gluconate available for treatment of acute calcium deficit.
Instruct the client to consume foods high in calcium